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Malik MH, Jabal MS, Kobeissi H, Gupta R, Bilgin C, Brinjikji W. Embolization of arteriovenous malformations of head and neck: A systematic review. Interv Neuroradiol 2023:15910199231219823. [PMID: 38105437 DOI: 10.1177/15910199231219823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Cervicofacial arteriovenous malformations (AVMs) are a significant source of morbidity. Endovascular embolization has emerged as a promising treatment technique for these lesions. However, current literature on cervicofacial AVM embolization mostly consists of single-agent oriented case series, and to date, no comprehensive study has compared the outcomes of available embolic agents. PURPOSE To investigate the performance of different embolic agents in the management of cervicofacial AVMs. METHODS We systematically searched Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials Scopus, and Web of Science. Studies providing data for the endovascular treatment of cervicofacial AVMs were included. The data regarding complication and cure rates were collected for each embolic agent. Pooled event rates were presented as descriptive statistics. RESULTS Eleven studies comprising 204 patients were included in the review. The overall complete and partial cure rates were 62.2% (127/204) and 36.2% (74/204), respectively. Embolization failed to achieve significant improvement in only 1.6% (3/204) of the patients. The complete cure rates were 87.5% (75-100%) for n-Butyl cyanoacrylate (NBCA, glue), 80.5% (61-100%) for Onyx (Medtronic, MN, USA), and 51.5% (18-85%) for ethanol. The overall complication rate was 30% (61/204). The complication rates were 33% (12.5-53%) for ethanol, 14% (0-28%) for Onyx, and 0% for NBCA. CONCLUSIONS Our systematic review supports that endovascular embolization is an effective treatment option for cervicofacial AVMs. In our review, the use of Onyx and NBCA was associated with consistently high complete cure rates and a promising safety profile. However, more research is needed to investigate the use of different embolic agents in the treatment of cervicofacial AVMs.
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Affiliation(s)
| | | | | | - Rishabh Gupta
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Mitchell SE, Martin RP, Terry P, Drant SE, Valle D, Dietz H, Sobreira N. Systemic artery to pulmonary artery aneurysm malformations associated with variants at MCF2L. Am J Med Genet A 2023; 191:1250-1260. [PMID: 36760094 DOI: 10.1002/ajmg.a.63141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/23/2022] [Accepted: 01/14/2023] [Indexed: 02/11/2023]
Abstract
Arteriovenous malformations (AVM) are characterized by abnormal vessels connecting arteries and veins resulting in a disruption of normal blood flow. Hereditary hemorrhagic telangiectasia (HHT) is the most common cause of pulmonary AVM characterized by a right to left shunt. Here we describe a distinct malformation where the flow of blood was from a systemic artery to the pulmonary artery (PA) resulting in a left to right shunt instead of the right to left shunt seen in individuals with HHT. This distinct malformation was identified in seven probands, one from a multiplex family containing 10 affected individuals from five generations. To identify the molecular basis of this distinct malformation, we performed exome sequencing (ES) on the seven probands and the affected paternal female cousin from the multiplex family. PhenoDB was used to prioritize candidate causative variants along with burden analysis. We describe the clinical and radiological details of the new systemic artery to PA malformation with or without pulmonary artery aneurysm (SA-PA(A)) and recommend distinct treatment techniques. Moreover, ES analysis revealed possible causative variants identified in three families with variants in a novel candidate disease gene, MCF2L. Further functional studies will be necessary to better understand the molecular mechanisms involved on SA-PA(A) malformation, however our findings suggest that MCF2L is a novel disease gene associated with SA-PA(A).
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Affiliation(s)
- S E Mitchell
- Russell H Morgan Department of Radiology, Interventional Section, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R P Martin
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - P Terry
- Pulmonary Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S E Drant
- Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - D Valle
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - H Dietz
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Sobreira
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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3
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Onishi M, Onishi Y, Yasumura S, Nakai H, Hamasaki M, Miyake M, Taniguchi T. Chest wall systemic artery-to-pulmonary artery vascular malformation treated by embolization of feeders and drainers: A case report. Radiol Case Rep 2022; 17:3395-3398. [PMID: 35880239 PMCID: PMC9307446 DOI: 10.1016/j.radcr.2022.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/25/2022] [Indexed: 11/17/2022] Open
Abstract
A 74-year-old woman presented with progressive dyspnea. Computed tomography revealed a large systemic artery-to-pulmonary artery vascular malformation (VM) on the right chest wall. Embolization of the VM was performed. First, the main drainers of the VM were retrogradely selected from the segmental pulmonary arteries and embolized using microcoils. Second, 2 main feeders of the VM were selected and embolized with N-butyl cyanoacrylate. Thus, marked flow reduction in the VM was achieved, and the patient's symptom improved dramatically. We believe that embolization of both feeders and drainers is an effective technique for treatment of a chest wall systemic artery-to-pulmonary artery VM.
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Affiliation(s)
- Motofumi Onishi
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
- Corresponding author.
| | - Yasuyuki Onishi
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
| | - Sumika Yasumura
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
| | - Hirotsugu Nakai
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
| | - Maki Hamasaki
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Takanori Taniguchi
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
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Malik V, Kramadhari H, Rathod J, Munde YW, Kovilapu UB. Peripheral Arteriovenous Malformations: Imaging and Endovascular Management Strategies. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1728986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractThe peripheral high-flow vascular malformation (HFVM) comprises arteriovenous malformation (AVM) and fistula (AVF), shows varied clinical presentation (ranging from subtle skin lesion to life-threatening congestive heart failure), and frequently poses diagnostic and therapeutic challenges. Importance of assigning a specific diagnosis to the vascular malformation cannot be overstated, as the treatment strategy is based on the type of vascular anomaly. Although the International Society for the Study of Vascular Anomalies (ISSVA) classification system is the most commonly accepted system for classifying congenital vascular anomalies in clinical practice, the Cho–Do et al classification is of utmost help in guiding optimal mode of treatment in peripheral AVM. Although transarterial approach remains the most commonly employed route for peripheral AVM embolization, the role of transvenous and direct percutaneous approach is ever increasing and the final decision on the approach depends on angioarchitecture of the AVM. In this article, we review various commonly employed classification systems for congenital vascular anomalies, and describe clinical features, imaging and treatment strategies for peripheral arteriovenous malformation (PAVM).
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Affiliation(s)
- Virender Malik
- Army Institute of Cardiothoracic sciences (AICTS), affiliated to Armed Forces Medical College, Pune, India
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Lee E, Shim DJ, Kim D, Lee JW. Endovascular Treatment of a Systemic-to-Pulmonary Artery Fistula: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:682-687. [PMID: 36238779 PMCID: PMC9432454 DOI: 10.3348/jksr.2020.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 11/15/2022]
Abstract
Systemic-to-pulmonary artery fistulas are rare. This condition may be congenital, post-traumatic, or post-inflammatory and can cause infection, hemorrhage, or pulmonary hypertension. Here, we report a case of an intercostal-to-pulmonary artery fistula, incidentally detected during the evaluation of dyspnea in a 67-year-old female. Retrograde transcatheter coil embolization in a dilated draining pulmonary artery was initially attempted. However, another draining pulmonary artery developed after 5 months. The intercostal arteries or systemic feeders were successfully embolized through a transarterial access. At the 10-month follow-up, the abnormally dilated vessels had regressed, and dyspnea had improved. Sequential or simultaneous retro- and antegrade transcatheter embolization may successfully treat pleural arterio-arterial fistulas.
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Affiliation(s)
- Eunbyul Lee
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Dong Jae Shim
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Doyoung Kim
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jung Whee Lee
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Embolization Techniques for Arteriovenous Malformations in Parkes-Weber Syndrome. Ann Vasc Surg 2020; 69:224-231. [DOI: 10.1016/j.avsg.2020.05.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/16/2022]
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Soulez G, Gilbert, MD, FRCPC P, Giroux, MD, FRCPC MF, Racicot, MD, FRCPC JN, Dubois J. Interventional Management of Arteriovenous Malformations. Tech Vasc Interv Radiol 2019; 22:100633. [DOI: 10.1016/j.tvir.2019.100633] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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He Q, Wang RK. Analysis of skin morphological features and real-time monitoring using snapshot hyperspectral imaging. BIOMEDICAL OPTICS EXPRESS 2019; 10:5625-5638. [PMID: 31799035 PMCID: PMC6865098 DOI: 10.1364/boe.10.005625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/11/2019] [Accepted: 09/20/2019] [Indexed: 05/07/2023]
Abstract
We propose a snapshot hyperspectral imaging system and methods for skin morphological feature analysis and real-time monitoring of skin activities. The analysis method includes a strategy using weighted subtractions between sub-channel images to extract absorption information due to specific chromophores within skin tissue, for example hemoglobin and melanin. Based on morphological analysis results, we carry out real-time monitoring of the skin features to verify the ability of this method to provide temporal responses of the skin tissue activities, which is experimentally shown to be useful in the measurement of heartrate, monitoring of the tissue recovery after a body exercise, and studying of the tissue response due to a vascular occlusion. Compared to conventional multispectral imaging system, the proposed system improves the device simplicity and is immune to motion artifacts. Coupled with the extraction algorithms, the hyperspectral imaging promises a robust skin assessment tool with abilities for qualitative visualization and potentially quantitative analysis of skin features, useful in the applications of cosmetics and clinical dermatology.
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Affiliation(s)
- Qinghua He
- Department of Bioengineering, University of Washington, Seattle, Washington 98105, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington 98105, USA
- Department of Ophthalmology, University of Washington, Seattle, Washington 98109, USA
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Ko SE, Do YS, Park KB, Kim DI, Heo SH, Bae SH, Park HS, Shin SW, Cho SK, Hyun D. Subclassification and Treatment Results of Ethanol Embolotherapy of Type II Arteriovenous Malformations of the Extremity and Body. J Vasc Interv Radiol 2019; 30:1443-1451. [PMID: 31229331 DOI: 10.1016/j.jvir.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of ethanol and coil embolization of type II arteriovenous malformation (AVM) according to a new subtype classification. MATERIALS AND METHODS Eighty-four type II AVMs in the body or extremity of 79 patients who underwent AVM treatment from 1996 to 2017 were retrospectively subclassified according to the angiographic morphology of the draining vein as type IIa (arterioles shunt to focal segment of single draining vein), type IIb (arterioles shunt to venous sac with multiple draining veins), and type IIc (arterioles shunt along long segment of draining vein). Coil and ethanol embolization of the focal or long segment of the draining vein or the venous sac was performed with direct puncture or transvenous approach according to subtype. Treatment outcomes, number of treatment sessions, and complications were analyzed. RESULTS AVM cure (ie, complete embolization) rates were 95%, 76%, and 65% in types IIa, IIb, and IIc AVMs, respectively. The cure rate of type IIa AVMs was significantly better than that of type IIc AVMs (P = .015). Median numbers of treatment sessions were 1 in types IIa and IIb AVMs and 2.5 in type IIc AVMs, with a significant difference between type IIc and the other 2 types (P < .05). Minor complications occurred in 20% of patents and major complications occurred in 7%. CONCLUSIONS The cure rate of type IIa AVMs was significantly better than that of type IIc AVMs, which also required significantly more treatment sessions than the other 2 types.
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Affiliation(s)
- Seong Eun Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul 06351, Korea
| | - Young Soo Do
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul 06351, Korea.
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul 06351, Korea
| | - Dong-Ik Kim
- Department of Surgery and Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul 06351, Korea
| | - Seon-Hee Heo
- Department of Surgery and Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul 06351, Korea
| | - Suk Hyun Bae
- Department of Radiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Hong Suk Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul 06351, Korea
| | - Sung Wook Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul 06351, Korea
| | - Sung Ki Cho
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul 06351, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul 06351, Korea
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Kitagawa A, Yamamoto T, Matsunaga N, Yamaji M, Ikeda S, Izumi Y, Hagihara M, Ota T, Ishiguchi T. Polidocanol Sclerotherapy Combined with Transarterial Embolization Using n-Butyl Cyanoacrylate for Extracranial Arteriovenous Malformations. Cardiovasc Intervent Radiol 2018; 41:856-866. [PMID: 29417264 PMCID: PMC5937878 DOI: 10.1007/s00270-017-1855-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022]
Abstract
Purpose To assess the safety and effectiveness of polidocanol sclerotherapy combined with transarterial embolization using a liquid adhesive agent (n-butyl cyanoacrylate, NBCA) for treatment of extracranial arteriovenous malformations (AVMs). Materials and Methods Twenty-three patients with symptomatic AVMs in the head and neck (6), upper (7) and lower extremity (10) with a mean age of 42 years (range 4–74) treated with polidocanol sclerotherapy were retrospectively assessed. AVMs were classified according to the angiographic morphology of the nidus. There were 2 type I, 6 type II, 6 type IIIa and 9 type IIIb. Arterial embolization using NBCA was performed to reduce arterial flow before sclerotherapy. Polidocanol mixed with contrast material or carbon dioxide was delivered by percutaneous direct puncture. Results Treatment was successfully performed in all patients. In the mean follow-up period of 38 months, symptoms resolved or improved in 20/23 patients (87.0%). AVMs were devascularized 100% in 2 patients, 76–99% in 13, 50–75% in 7 and < 50% in 1. More than 50% devascularization was seen in 22 patients (95.6%). Two (8%) patients had complete remission, 17 (74%) had partial remission and 3 (13%) had no remission. There was no aggravation. Treatment was considered effective (complete and partial remission) in 20 patients (87.0%). Minor complications including localized arterial thrombosis (2) and spontaneously healing skin ulcer (1) were seen in 2 patients (8.7%). There were no major procedure-related complications. Conclusion Polidocanol sclerotherapy combined with transarterial embolization using NBCA is safe and effective for treating extracranial AVMs with an acceptable risk of minor complications.
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Affiliation(s)
- Akira Kitagawa
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan.
| | - Takahiro Yamamoto
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Nozomu Matsunaga
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Mayako Yamaji
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Shuji Ikeda
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Yuichiro Izumi
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Makiyo Hagihara
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Toyohiro Ota
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Tsuneo Ishiguchi
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
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Absolute Ethanol Embolization Combined with Surgical Resection of Scalp Arteriovenous Malformations: Interim Results. J Vasc Interv Radiol 2017; 29:312-319. [PMID: 29295765 DOI: 10.1016/j.jvir.2017.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 09/26/2017] [Accepted: 10/07/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess treatment methods, interim results, and complications of absolute ethanol embolization combined with surgical resection of scalp arteriovenous malformations (AVMs). MATERIALS AND METHODS From September 2012 to January 2015, 15 consecutive patients (8 male and 7 female) with scalp AVMs underwent staged ethanol embolizations. Ethanol embolization was performed using transcatheter and/or direct puncture techniques. Ten patients with scalp AVMs with a dominant outflow vein (DOV) also underwent coil deployment before ethanol embolization. Two patients underwent surgical resection after ethanol embolization was achieved. Follow-up evaluations included clinical outcome of symptoms and signs and imaging at 1.5 months, 6 months, and annually thereafter. RESULTS In 15 patients, 33 ethanol embolizations were performed; 16 coil deployments were performed in 10 patients who had scalp AVMs with a DOV. Of 15 patients, 8 (53.3%) were cured, 2 of whom underwent surgical resection. All 8 patients showed no recurrence in the follow-up period (range, 12-48 months; mean, 25 months). Seven patients (46.7%) had partial remission and will need further treatment sessions for residual AVMs (range, 1-12 months; mean, 7 months). In 3 of 15 patients (20%), 7 minor complications (skin blisters and necrosis) occurred. All minor complications healed with wound dressing and observation. There were no major complications. CONCLUSIONS Ethanol embolization has the potential for cure in management of scalp AVMs, with an acceptable risk of minor and major complications. Once AVMs are devascularized, surgical resection can be performed to improve cosmetic results.
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Gilbert P, Dubois J, Giroux MF, Soulez G. New Treatment Approaches to Arteriovenous Malformations. Semin Intervent Radiol 2017; 34:258-271. [PMID: 28955115 DOI: 10.1055/s-0037-1604299] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Arteriovenous malformations (AVMs) are high-flow vascular anomalies that have demonstrated a very high recurrence rate after endovascular treatment, surgical treatment, or a combination of both. Surgical treatments have shown good response when they are small and well localized but a poor response when diffuse. A better understanding of the nature of the lesion has led to a better response rate and a safer treatment for these patients. This has been accomplished through a detailed understanding of the angioarchitecture of the lesion, enabling a tailored approach in reaching and targeting the nidus of the AVM with different liquid embolic agents, more specifically ethanol. Flow reduction techniques help in exposing the nidus to sclerosant agents. A clinical classification, the Schobinger classification, will help determine the appropriate time to start or to pursue therapy.
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Affiliation(s)
- Patrick Gilbert
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Josée Dubois
- Department of Radiology, Centre Hospitalier Universitaire Ste Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie France Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
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Wang D, Su L, Han Y, Wang Z, Zheng L, Fan X. Absolute Ethanol Embolisation of Mandibular Arteriovenous Malformations Following Direct Percutaneous Puncture and Release of Coils via a Microcatheter. Eur J Vasc Endovasc Surg 2017; 53:862-869. [DOI: 10.1016/j.ejvs.2017.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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Saeed Kilani M, Lepennec V, Petit P, Magalon G, Casanova D, Bartoli JM, Vidal V. Embolization of peripheral high-flow arteriovenous malformations with Onyx. Diagn Interv Imaging 2017; 98:217-226. [DOI: 10.1016/j.diii.2016.06.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 04/29/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
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Saeed Kilani M, Zehtabi F, Lerouge S, Soulez G, Bartoli JM, Vidal V, Badran MF. New Alcohol and Onyx Mixture for Embolization: Feasibility and Proof of Concept in Both In Vitro and In Vivo Models. Cardiovasc Intervent Radiol 2017; 40:735-743. [PMID: 28050660 DOI: 10.1007/s00270-016-1559-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/22/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Onyx and ethanol are well-known embolic and sclerotic agents that are frequently used in embolization. These agents present advantages and disadvantages regarding visibility, injection control and penetration depth. Mixing both products might yield a new product with different characteristics. The aim of this study is to evaluate the injectability, radiopacity, and mechanical and occlusive properties of different mixtures of Onyx 18 and ethanol in vitro and in vivo (in a swine model). MATERIALS AND METHODS Various Onyx 18 and ethanol formulations were prepared and tested in vitro for their injectability, solidification rate and shrinkage, cohesion and occlusive properties. In vivo tests were performed using 3 swine. Ease of injection, radiopacity, cohesiveness and penetration were analyzed using fluoroscopy and high-resolution CT. RESULTS All mixtures were easy to inject through a microcatheter with no resistance or blockage in vitro and in vivo. The 50%-ethanol mixture showed delayed copolymerization with fragmentation and proximal occlusion. The 75%-ethanol mixture showed poor radiopacity in vivo and was not tested in vitro. The 25%-ethanol mixture showed good occlusive properties and accepted penetration and radiopacity. CONCLUSION Mixing Onyx and ethanol is feasible. The mixture of 25% of ethanol and 75% of Onyx 18 could be a new sclero-embolic agent. Further research is needed to study the chemical changes of the mixture, to confirm the significance of the added sclerotic effect and to find out the ideal mixture percentages.
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Affiliation(s)
- Mohammad Saeed Kilani
- Hôpital cardiologique, Centre Hospitalier Universitaire (CHRU) de Lille, Boulevard Jules LECLERQ, 59037, Lille, France.
- Experimental Interventional Imaging Laboratory, CERIMED, Marseilles, France.
| | - Fatemeh Zehtabi
- Department of Mechanical Engineering, école de technologie supérieure (ETS) & CHUM Research center (CRCHUM), Montreal, Canada
| | - Sophie Lerouge
- Department of Mechanical Engineering, école de technologie supérieure (ETS) & CHUM Research center (CRCHUM), Montreal, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke East, H2L 4M1, Montreal, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, Canada
| | - Jean Michel Bartoli
- Department of Medical Imaging, University Hospital Timone, Marseilles, France
| | - Vincent Vidal
- Hôpital cardiologique, Centre Hospitalier Universitaire (CHRU) de Lille, Boulevard Jules LECLERQ, 59037, Lille, France
- Aix-Marseille University, Marseille, France
- Interventional Radiology Section, Department of Medical Imaging, University Hospital TIMONE, Marseille, France
| | - Mohammad F Badran
- Radiology Department, King Faisal Specialist Hospital and Research Center, MBC 28, PO Box 3354, Riyadh, 11211, Saudi Arabia
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Kuhara A, Tanaka N, Koganemaru M, Kugiyama T, Kiyokawa K, Abe T. A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch. Cardiovasc Intervent Radiol 2016; 40:788-792. [PMID: 27999914 DOI: 10.1007/s00270-016-1548-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/14/2016] [Indexed: 11/28/2022]
Abstract
Management of arteriovenous malformations (AVMs) is challenging, and there is no consensus regarding either the ideal approach or the treatment timing. Percutaneous embolization is the most frequent approach currently used and is considered the first-line technique for AVMs. There is an ongoing discussion about the best technical approach to embolize AVMs. AVMs associated with a dominant outflow vein (DOV) are rare. Embolization of both the DOV and the nidus is considered more effective. Herein, we report a novel technique of transvenous embolization of a DOV under negative pressure from an arterial balloon catheter in a case of a peripheral AVM. This technique allows the embolization of the DOV and the nidus retrogradely.
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Affiliation(s)
- Asako Kuhara
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Norimitsu Tanaka
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masamichi Koganemaru
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomoko Kugiyama
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Kensuke Kiyokawa
- Department of Plastic & Reconstructive Surgery and Maxillofacial Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Hwang JH, Do YS, Park KB, Chung HH, Park HS, Hyun D. Embolization of Congenital Renal Arteriovenous Malformations Using Ethanol and Coil Depending on Angiographic Types. J Vasc Interv Radiol 2016; 28:64-70. [PMID: 27865576 DOI: 10.1016/j.jvir.2016.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/04/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate effectiveness and safety of embolization of congenital renal arteriovenous malformations (AVMs) using ethanol and/or coil according to angiographic type. MATERIALS AND METHODS Between August 2010 and October 2015, 11 patients (13 sessions; 10 women and 1 man; mean age, 50.8 y) with congenital renal AVMs were treated using ethanol and/or coils via 2 approaches (transarterial access or direct puncture). Demographics, clinical findings, diagnostic modalities, angiographic types, technical and clinical success rates, and complications were reviewed. Renal AVMs were classified into 3 angiographic types, and treatment was based on this classification. RESULTS Technical success rate was 91% (10/11), and clinical success rate was 100% (11/11). Of patients, 7 had type III AVMs, 3 had type I AVMs, and 1 had type II AVM. Embolic agents were ethanol in 5 patients, coils with ethanol in 3 patients, and coils in 3 patients. Of the 8 patients treated with ethanol, 6 had infarcted renal areas of 3.5%-30% (mean, 14.6%). After a mean follow-up period of 16.3 months, there was no evidence of recurrent AVMs on imaging or laboratory studies. CONCLUSIONS Embolization of congenital renal AVMs via transarterial or direct percutaneous approaches using ethanol and/or coils based on a simple angiographic classification was safe and effective and elicited good outcomes. Most of the patients with congenital renal AVMs were women.
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Affiliation(s)
- Jin Ho Hwang
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Young Soo Do
- Department of Radiology, Samsung Medical Center, 50 Irwon-Dong, Gangnam Gu, Seoul 135-710, Korea.
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, 50 Irwon-Dong, Gangnam Gu, Seoul 135-710, Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
| | - Hong Suk Park
- Department of Radiology, Samsung Medical Center, 50 Irwon-Dong, Gangnam Gu, Seoul 135-710, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, 50 Irwon-Dong, Gangnam Gu, Seoul 135-710, Korea
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18
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Hansing CE, Marquardt JP, Sutton DM, York JD. Balloon-Occluded Retrograde Transvenous Obliteration of a Gastric Vascular Malformation: An Innovative Approach to Treatment of a Rare Condition. Cardiovasc Intervent Radiol 2016; 40:310-314. [DOI: 10.1007/s00270-016-1470-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/19/2016] [Indexed: 11/28/2022]
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19
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Su L, Wang D, Han Y, Wang Z, Fan X. Salvage treatment of hemorrhagic arteriovenous malformations in jaws. J Craniomaxillofac Surg 2015; 43:1082-7. [PMID: 26154397 DOI: 10.1016/j.jcms.2015.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 04/17/2015] [Accepted: 06/08/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To present our clinical experience on embolotherapy of arteriovenous malformations (AVMs) in jaws with acute hemorrhage. MATERIALS AND METHODS Twelve patients with a history of hemorrhage were selected for this study. Continuous interdental sling suture, digital pressure on the extraction socket, and iodoform gauze packed into the socket and fixed with sutures to the adjacent gum were used for temporary hemostasis before embolization. Fiberoptic bronchoscopy was used in all cases to facilitate endotracheal intubation. Absolute ethanol combined with coils was used as method of embolization. RESULTS Eight patients presented with intermittent interdental gum bleeding or controlled hemostasis before embolization. Four patients presented with torrential hemorrhage around the tooth, controlled by continuous pressure on the tooth and bilateral gum for temporary hemostasis. All patients were successfully salvaged before embolization. Ten of 12 patients were cured, and 2 had partial remission. Follow-up ranged from 12 to 26 months (mean, 16.5 months) for all patients, and there was no recurrence of the lesions. CONCLUSIONS The treatment of hemorrhagic AVMs of the jaw requires a multidisciplinary team approach; such cases can be successfully salvaged and stably controlled by embolization with coils and absolute ethanol.
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Affiliation(s)
- Lixin Su
- Department of Interventional Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Deming Wang
- Department of Interventional Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yifeng Han
- Department of Interventional Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenfeng Wang
- Department of Interventional Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xindong Fan
- Department of Interventional Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Su L, Wang D, Han Y, Wang Z, Zheng L, Fan X. Absolute Ethanol Embolization of Infiltrating-diffuse Extracranial Arteriovenous Malformations in the Head and Neck. Eur J Vasc Endovasc Surg 2015; 50:114-21. [DOI: 10.1016/j.ejvs.2015.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 02/27/2015] [Indexed: 02/07/2023]
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21
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Ge BH, Copelan A, Scola D, Watts MM. Iatrogenic percutaneous vascular injuries: clinical presentation, imaging, and management. Semin Intervent Radiol 2015; 32:108-22. [PMID: 26038619 DOI: 10.1055/s-0035-1549375] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Vascular interventional radiology procedures are relatively safe compared with analogous surgical procedures, with overall major complication rates of less than 1%. However, major vascular injuries resulting from these procedures may lead to significant morbidity and mortality. This review will discuss the etiology, clinical presentation, diagnosis, and management of vascular complications related to percutaneous vascular interventions. Early recognition of these complications and familiarity with treatment options are essential skills for the interventional radiologist.
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Affiliation(s)
- Benjamin H Ge
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Copelan
- Department of Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Dominic Scola
- Department of Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Micah M Watts
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Conway AM, Qato K, Drury J, Rosen RJ. Embolization techniques for high-flow arteriovenous malformations with a dominant outflow vein. J Vasc Surg Venous Lymphat Disord 2015; 3:178-83. [DOI: 10.1016/j.jvsv.2014.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/22/2014] [Indexed: 11/25/2022]
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23
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Wohlgemuth WA, Müller-Wille R, Teusch VI, Dudeck O, Cahill AM, Alomari AI, Uller W. The Retrograde Transvenous Push-Through Method: A Novel Treatment of Peripheral Arteriovenous Malformations with Dominant Venous Outflow. Cardiovasc Intervent Radiol 2015; 38:623-31. [DOI: 10.1007/s00270-015-1063-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
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24
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Ethanol Embolotherapy of High-flow Auricular Arteriovenous Malformations with Electrolytically Detachable Coil-assisted Dominant Outflow Vein Occlusion. Eur J Vasc Endovasc Surg 2014; 48:576-84. [DOI: 10.1016/j.ejvs.2014.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/01/2014] [Indexed: 11/19/2022]
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25
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Yakes W, Baumgartner I. Interventional treatment of arterio-venous malformations. GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00772-013-1303-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Vascular malformations (VMs) comprise a wide spectrum of lesions that are classified by content and flow characteristics. These lesions, occurring in both focal and diffuse forms, can involve any organ and tissue plane and can cause significant morbidity in both children and adults. Since treatment strategy depends on the type of malformation, correct diagnosis and classification of a vascular lesion are crucial. Slow-flow VMs (venous and lymphatic malformations) are often treated by sclerotherapy, whereas fast-flow lesions (arteriovenous malformations) are generally managed with embolization. In addition, some cases of VMs are best treated surgically. This review will present an overview of VMs in the female pelvis as well as a discussion of endovascular therapeutic techniques.
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Affiliation(s)
- Brian M Christenson
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Denver Anschutz Medical Campus, Aurora, Colorado
| | - Matthew G Gipson
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Denver Anschutz Medical Campus, Aurora, Colorado
| | - Mitchell T Smith
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Denver Anschutz Medical Campus, Aurora, Colorado
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Takeuchi Y, Morishita H, Sato Y, Hamaguchi S, Sakamoto N, Tokue H, Yonemitsu T, Murakami K, Fujiwara H, Sofue K, Abe T, Higashihara H, Nakajima Y, Sato M. Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition. Jpn J Radiol 2014; 32:500-17. [PMID: 24889662 DOI: 10.1007/s11604-014-0328-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/29/2014] [Indexed: 01/01/2023]
Abstract
Cyanoacrylates are a group of fast-acting adhesives. They form low viscosity liquids in the monomer state and instantly polymerize to become adhesive upon contact with ionic substances. Since the 1950s, they have been used around the world for industrial and household purposes. N-butyl cyanoacrylate (NBCA) is a cyanoacrylate that is commonly used for medical care, and the closure of skin wounds with NBCA has been found to promote hemostasis. However, in Japan, the intravascular injection of NBCA is considered to be off-label use, except during the treatment of gastric varices under endoscopy. The use of NBCA in embolotherapy is considered when the target vessels cannot be cannulated superselectively, for vascular diseases that require long segments of the target vessel to be embolized, or for patients in a hypocoagulable state. NBCA-based embolotherapy can be used to treat vascular malformations, acute hemorrhaging, tumors, and venous disease. The complications associated with NBCA-based embolotherapy include tissue ischemia, hemorrhaging, systemic or local reactions, and catheter adhesion to blood vessels. NBCA is mixed with Lipiodol to make it radiopaque and to adjust its polymerization time. Since there are various technical aspects to performing NBCA-based embolotherapy safely, it should be carried out by, or with the assistance of, proficient interventional radiologists.
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Affiliation(s)
- Yoshito Takeuchi
- Department of Radiology, North Medical Center, Kyoto Prefectural University of Medicine, 481, Otokoyama, Yosanocho, Yosagun, Kyoto, 629-2261, Japan,
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Malformação arteriovenosa da artéria hipogástrica — A propósito de um caso clínico. ANGIOLOGIA E CIRURGIA VASCULAR 2014. [DOI: 10.1016/s1646-706x(14)70028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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29
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Ethanol embolotherapy of foot arteriovenous malformations. J Vasc Surg 2013; 58:1619-26. [DOI: 10.1016/j.jvs.2013.06.074] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/23/2013] [Accepted: 06/26/2013] [Indexed: 11/19/2022]
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Ethanolamine oleate sclerotherapy combined with transarterial embolization using n-butyl cyanoacrylate for extracranial arteriovenous malformations. Cardiovasc Intervent Radiol 2013; 37:371-80. [PMID: 23737022 DOI: 10.1007/s00270-013-0653-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study was designed to assess the safety and effectiveness of ethanolamine oleate (EO) sclerotherapy combined with transarterial embolization using a liquid adhesive agent (n-butyl cyanoacrylate, NBCA) for treatment of extracranial arteriovenous malformations (AVMs). METHODS Twenty-four patients with symptomatic AVMs in the head and neck (n = 15), extremity (n = 5), and trunk (n = 4) with a mean age of 44 years (range, 18-78) treated with EO sclerotherapy were retrospectively assessed. AVMs were classified according to the angiographic morphology of the nidus. There were 7 type II (arteriolovenous fistulae), 6 type IIIa (arteriolovenulous fistulae with nondilated fistula), and 11 type IIIb (arteriolovenulous fistulae with dilated fistula). Transarterial embolization using NBCA was performed to reduce arterial flow before sclerotherapy. EO mixed with contrast material was delivered by percutaneous direct puncture or by catheterization into the draining vein under balloon occlusion. RESULTS Three (13%) of 24 patients were cured, 17 (71%) had partial remission, and 4 (16%) no remission. Treatment was considered effective (cure and partial remission) in 20 patients (83%). Four patients (16%) experienced transient minor complications, including self-healing skin ulcer (n = 3) and localized deep venous thrombosis (n = 1). There were no major complications. CONCLUSIONS EO sclerotherapy combined with transarterial embolization using NBCA is safe and effective for treating extracranial AVMs with an acceptable risk of minor complications.
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Abstract
OPINION STATEMENT The incidence of vascular access site related complications ranges between 0.8 % to 1.8 % of diagnostic cardiac catheterization and up to 9 % of percutaneous coronary interventions (PCI) [1]. The femoral vessels at the groin are used as the access site for the majority of percutaneous coronary, peripheral arterial and venous, and electrophysiologic interventions. With emergence of endovascular abdominal aortic aneurysm repair (EVAR), thoracic endovascular aneurysm repair (TEVAR), and transcatheter aortic valve replacement (TAVR), larger access sheaths (up to 18Fr-24Fr) are required, which further increases the potential for access site complications. The true incidence of access site complications arising from non-coronary interventions is unknown; hence it is likely that the total incidence of vascular access site complications is greatly underestimated. Vascular closure devices (VCDs), radial artery access, fluoroscopic guidance, and ultrasound guidance have all been used with a hope to minimize these complications. Despite these attempts, vascular access complications have not been eliminated. Cardiovascular specialists must promptly identify these complications and manage them appropriately.
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Predictive Factors for Response of Peripheral Arteriovenous Malformations to Embolization Therapy: Analysis of Clinical Data and Imaging Findings. J Vasc Interv Radiol 2012; 23:1478-86. [DOI: 10.1016/j.jvir.2012.08.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 07/24/2012] [Accepted: 08/09/2012] [Indexed: 11/21/2022] Open
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Do YS, Kim YW, Park KB, Kim DI, Park HS, Cho SK, Shin SW, Park YJ. Endovascular treatment combined with emboloscleorotherapy for pelvic arteriovenous malformations. J Vasc Surg 2012; 55:465-71. [PMID: 22051867 DOI: 10.1016/j.jvs.2011.08.051] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 08/23/2011] [Accepted: 08/26/2011] [Indexed: 12/30/2022]
Affiliation(s)
- Young Soo Do
- Department of Radiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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34
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Imaging and management of vascular malformations. Clin Radiol 2011; 66:1208-18. [DOI: 10.1016/j.crad.2011.06.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 06/15/2011] [Accepted: 06/29/2011] [Indexed: 11/23/2022]
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van der Linden E, van Baalen JM, Pattynama PMT. Retrograde Transvenous Ethanol Embolization of High-flow Peripheral Arteriovenous Malformations. Cardiovasc Intervent Radiol 2011; 35:820-5. [DOI: 10.1007/s00270-011-0265-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
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Legiehn GM, Heran MKS. A Step-by-Step Practical Approach to Imaging Diagnosis and Interventional Radiologic Therapy in Vascular Malformations. Semin Intervent Radiol 2011; 27:209-31. [PMID: 21629410 DOI: 10.1055/s-0030-1253521] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Within vascular anomalies, vascular malformations are those present at birth that grow with the patient and exhibit abnormal dilated vascular channels lined by mature endothelium. Vascular tumors, the other group of vascular anomalies, demonstrate endothelial hypercellularity. Vascular malformations are further divided into low-flow varieties (capillary, venous, and lymphatic malformations) and high-flow varieties (arteriovenous malformation and fistula). All malformations exhibit a predictable group of clinical patterns that vary in severity and rate of progression. The interventional radiologist must incorporate this clinical data with characteristic ultrasound and magnetic resonance findings to arrive at a diagnosis. One must then decide in a multidisciplinary fashion, based on objective clinical criteria and image-based morphology, if the patent is a candidate for intervention. Sclerotherapy is a technique used to treat vascular malformations whereby an endothelial-cidal agent is introduced into the endoluminal compartment to initiate vascular closure. The high flow rate of an arteriovenous malformation requires the incorporation of superselective transarterial, direct, and transvenous access with flow reduction techniques to deliver adequate dose of sclerosant and embolic to the nidus. Satisfactory outcomes are seen in over half of all malformations patients. Similar treatment-related complications are seen between malformations but are lowest in lymphatic and highest in arteriovenous malformations.
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Affiliation(s)
- Gerald M Legiehn
- Division of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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37
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van der Linden E, Otoide-Vree M, Pattynama PMT. Percutaneous Treatment of Peripheral Vascular Malformations in Children: Long-Term Clinical Outcome. Cardiovasc Intervent Radiol 2011; 35:316-24. [DOI: 10.1007/s00270-011-0170-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 04/07/2011] [Indexed: 11/28/2022]
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Cahill AM, Nijs ELF. Pediatric vascular malformations: pathophysiology, diagnosis, and the role of interventional radiology. Cardiovasc Intervent Radiol 2011; 34:691-704. [PMID: 21409475 DOI: 10.1007/s00270-011-0123-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 02/01/2011] [Indexed: 01/19/2023]
Abstract
The Mulliken and Glowacki classification (1982) differentiated vascular anomalies into two groups based on their endothelial characteristics: hemangiomas and vascular malformations. Vascular anomalies are localized defects of the vasculature that affect a limited number of vessels in a restricted area of the body. These defects are secondary to errors in vascular morphogenesis. Depending on the type of vessel involved, the vascular malformation group was subdivided into high-flow (such as arteriovenous malformation and arteriovenous fistula) and low-flow lesions (such as venous and lymphatic malformations). Depending on the type of lesion, the location and degree of involvement and the clinical effect, different types of treatment would be required. For the purpose of this review, we concentrate solely on vascular malformations: the clinical features, genetics, diagnosis, and current treatment options.
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Affiliation(s)
- Anne Marie Cahill
- Department of Interventional Radiology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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39
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Extremity Arteriovenous Malformations Involving the Bone: Therapeutic Outcomes of Ethanol Embolotherapy. J Vasc Interv Radiol 2010; 21:807-16. [DOI: 10.1016/j.jvir.2010.01.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 01/01/2010] [Accepted: 01/26/2010] [Indexed: 01/25/2023] Open
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Maftei N, Howard A, Brown LC, Gunning MP, Standfield NJ. The surgical management of 73 vascular malformations and preoperative predictive factors of major haemorrhage--a single centre experience. Eur J Vasc Endovasc Surg 2009; 38:488-97. [PMID: 19660969 DOI: 10.1016/j.ejvs.2009.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 06/20/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In our series of patients with congenital vascular malformations (CVMs) we investigate the preoperative factors for predicting major haemorrhage at surgery and propose an algorithm for their surgical management. DESIGN This is a partly prospective case series of patients with severe symptoms/complications due to CVMs. MATERIALS AND METHODS Data were collected on 73 consecutive procedures in 41 patients with CVMs from 1992 to 2006 at a large university hospital and the association of following factors with blood loss during the procedure were investigated: type of procedure, possibility of proximal tourniquet use, lesion flow characteristics, previous history of major haemorrhage with CVM surgery, platelet counts and length of hospital stay. RESULTS Significantly higher blood loss was associated with debulking surgery (p=0.006) and with previous history of major haemorrhage during CVM surgery, (p=0.041). Blood loss was higher in lesions where proximal tourniquet application was not possible (p=0.093). High-flow lesions were not strongly associated with major blood loss (p=0.288). Major blood loss (>2l) occurred in 16 (20.8%) procedures performed on 11 (26.2%) patients, but this did not prolong hospital stay. CONCLUSION Surgery can potentially improve morbidity/mortality in patients with life/limb-threatening complications or severe symptoms due to CVMs, providing they are managed in multidisciplinary specialised centres.
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Affiliation(s)
- N Maftei
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, Department of Vascular Surgery, London, UK.
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van der Linden E, Pattynama PMT, Heeres BC, de Jong SC, Hop WCJ, Kroft LJM. Long-term Patient Satisfaction after Percutaneous Treatment of Peripheral Vascular Malformations. Radiology 2009; 251:926-32. [DOI: 10.1148/radiol.2513081579] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pharmacological Treatment of a Diffuse Arteriovenous Malformation of the Upper Extremity in a Child. J Craniofac Surg 2009; 20 Suppl 1:597-602. [DOI: 10.1097/scs.0b013e3181927f1e] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cho SK, Do YS, Kim DI, Kim YW, Shin SW, Park KB, Ko JS, Lee AR, Choo SW, Choo IW. Peripheral arteriovenous malformations with a dominant outflow vein: results of ethanol embolization. Korean J Radiol 2008; 9:258-67. [PMID: 18525229 PMCID: PMC2627257 DOI: 10.3348/kjr.2008.9.3.258] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective To assess retrospectively the treatment results of ethanol embolization of peripheral arteriovenous malformations (AVMs) with a dominant outflow vein (DOV). Materials and Methods Nineteen patients who had peripheral AVMs with a DOV were enrolled in this study (mean age, 29.7 years; range, 15-42 years). Fifty-one ethanol embolizations (mean, 2.7; range, 1-8) were performed by direct puncture (n = 29), the transarterial approach (n = 13), the transvenous approach (n = 5), or a combination of methods (n = 4) under general anesthesia. Coil and/or core-removed guide wire embolization of the DOV or another flow occlusion technique (i.e., use of an external pneumatic pressure cuff) to achieve vascular stasis were required in all patients during ethanol embolization. Clinical follow-up (mean, 22.2 months; range, 1-53 months) was performed for all patients, and imaging follow-up (mean, 22.1 months; range, 2-53 months) from the last treatment session was performed for 14 patients. The therapeutic outcome (cure, improvement, no change, or aggravation) was assessed according to the clinical response and the degree of devascularization at angiography. Results Ethanol embolization was considered as an effective procedure in all patients. Thirteen (68%) of 19 patients were cured and six displayed improvement. Three of six patients with improvement needed further treatment sessions for residual AVMs. Four patients (21%) experienced a total of eight complications. Five complications (three events of a distal embolism and one event each of a urinary bladder necrosis and a brain infarct related to the accidental cannulation of the common carotid artery during insertion of the Swan-Ganz catheter) were major and three complications (skin necrosis) were minor. Conclusion Peripheral AVMs with a DOV can be effectively treated with a high cure rate by the use of ethanol embolization alone or in conjunction with the use of coil and/or core-removed guide wire embolization.
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Affiliation(s)
- Sung Ki Cho
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Górriz Gómez E, Carreira J. Tratamiento percutáneo de las malformaciones vasculares periféricas con una mezcla de polidocanol y CO2. Experiencia inicial. RADIOLOGIA 2008; 50:424-9. [DOI: 10.1016/s0033-8338(08)76058-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bae S, Do YS, Shin SW, Park KB, Kim DI, Kim YW, Cho SK, Choo SW, Choo IW. Ethanol embolotherapy of pelvic arteriovenous malformations: an initial experience. Korean J Radiol 2008; 9:148-54. [PMID: 18385562 PMCID: PMC2627228 DOI: 10.3348/kjr.2008.9.2.148] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective We retrospectively assessed the results of performing ethanol embolization for pelvis arteriovenous malformations (AVMs). Materials and Methods During the past 10 years, eight patients (8 females, age range: 27-52 years) with AVMs in the pelvic wall (n = 3) and uterus (n = 5) underwent staged ethanol embolizations (range: 1-5, mean: 2.5) under general anesthesia. Ethanol embolization was performed by the use of the transcatheter and/or direct puncture techniques. Clinical follow-up was performed for all of the patients, and imaging follow-up was available for seven patients. The therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms, as well as the degree of devascularization observed on post-procedural angiography. Results During the 20 sessions of ethanol embolization, the solitary transarterial approach was used 14 times, the transvenous approach was used three times and direct puncture was used once. For two patients, the transarterial and transvenous or direct puncture approaches were used together in one session. For four patients, ethanol and coils were used as embolic agents, and n-butyl cyanoacrylate (NBCA) and ethanol were used in one patient. Seven (88%) of eight patients were cured of their AVMs and one patient (12%) displayed improvement. Major complications were seen in two patients (25%). Conclusion Ethanol embolization is effective for the treatment of pelvic arteriovenous malformations, though there is a chance of a major complication.
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Affiliation(s)
- Sooho Bae
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Do YS, Park KB, Cho SK. How Do We Treat Arteriovenous Malformations (Tips and Tricks)? Tech Vasc Interv Radiol 2007; 10:291-8. [PMID: 18572144 DOI: 10.1053/j.tvir.2008.03.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vidal V, Jacquier A, Le Corroller T, Moulin G, Bartoli JM. Traitement radiologique des malformations artérioveineuses périphériques. ANN CHIR PLAST ESTH 2006; 51:447-55. [PMID: 17007981 DOI: 10.1016/j.anplas.2006.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Management of high-flow arteriovenous malformation remain often problematic. Complete eradication of the nidus is the only potential cure, but this, however, is often difficult if not impossible. Frequently, a multidisciplinary approach is required. In these article, techniques and results of the endovascular management of MAV are discussed.
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Affiliation(s)
- V Vidal
- Service de radiologie, CHU de Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
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Cho SK, Do YS, Shin SW, Kim DI, Kim YW, Park KB, Kim EJ, Ahn HJ, Choo SW, Choo IW. Arteriovenous Malformations of the Body and Extremities: Analysis of Therapeutic Outcomes and Approaches According to a Modified Angiographic Classification. J Endovasc Ther 2006; 13:527-38. [PMID: 16928170 DOI: 10.1583/05-1769.1] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To propose a modified angiographic classification for peripheral arteriovenous malformations (AVMs) and to determine its value for assessing therapeutic outcomes and approaches to ethanol embolization of AVMs in the body and extremities. METHODS AVMs of the trunk and extremities were categorized according to the angiographic morphology of the nidus: type I (arteriovenous fistulae), type II (arteriolovenous fistulae), type IIIa (arteriolovenulous fistulae with non-dilated fistula), and type IIIb (arteriolovenulous fistulae with dilated fistula). Sixty-six patients (41 women; mean age 28.3 years, range 5-53) with inoperable AVMs in the body and extremities who underwent staged ethanol embolizations were retrospectively analyzed. Therapeutic outcomes and approaches were evaluated according the above classification system. RESULTS The 66 AVMs were composed of 30 (45%) type IIIb, 13 (20%) type II, 12 (18%) mixed types IIIa and IIIb, 9 (14%) mixed types II and IIIb, and 2 (3%) type IIIa. Ethanol embolization was most effective for type II (100%), and more effective for type IIIb (83%) than for type IIIa or mixed types (< or = 50%). Despite the use of the transarterial approach, direct puncture and transvenous approaches were more relevant for treating type II AVMs. Only the transarterial approach was used for treating type IIIa; both direct puncture and transarterial approaches were used for treating the other types. CONCLUSION The described angiographic classification provides considerable information concerning the characteristics of AVMs in the body and extremities, the optimal therapeutic approach, and the likely therapeutic outcome.
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Affiliation(s)
- Sung Ki Cho
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Legiehn GM, Heran MKS. Classification, diagnosis, and interventional radiologic management of vascular malformations. Orthop Clin North Am 2006; 37:435-74, vii-viii. [PMID: 16846771 DOI: 10.1016/j.ocl.2006.04.005] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Vascular anomalies are comprised of either hemangiomas or vascular malformations.Low-flow vascular malformations can be divided into capillary, venous, and lymphatic types and are usually present at birth, undergo pari passu growth, and produce symptoms related to mass effect or stasis. High-flow malformations are comprised pre-dominantly of arteriovenous malformations that follow a more aggressive clinical course of hyperemia, adjacent mass effect, steal phenomenon, tissue destruction, and ultimately high output failure. Ultrasound, CT, nuclear medicine, angiography, and particularly MRI have greatly enhanced diagnostic accuracy and provide detailed information for percutaneous and surgical treatment planning and an objective means of following therapeutic efficacy. Interventional radiologic percutaneous sclerotherapy for low-flow lesions and embolosclerotherapy for high-flow lesions with or without adjunctive surgical intervention have become the mainstay of therapy.
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Affiliation(s)
- Gerald M Legiehn
- Department of Radiology, Division of Interventional Radiology, Vancouver General Hospital, University of British Columbia, 899 West Twelfth Avenue, Vancouver, British Columbia, Canada, V5Z 1M9.
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Do YS, Yakes WF, Shin SW, Lee BB, Kim DI, Liu WC, Shin BS, Kim DK, Choo SW, Choo IW. Ethanol embolization of arteriovenous malformations: interim results. Radiology 2005; 235:674-82. [PMID: 15858106 DOI: 10.1148/radiol.2352040449] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess retrospectively the interim results and the complications of ethanol embolization treatment of arteriovenous malformations (AVMs). MATERIALS AND METHODS Institutional review board approval was obtained for a retrospective review of patient medical and imaging records. Informed consent was not required by the institutional review board. Written consent for the procedure was obtained from all patients after a discussion about the advantages and risks of the procedure. After a general anesthetic was administered, 40 patients (16 male, 24 female; age range, 9-53 years) with inoperable AVMs in the body and extremities underwent staged ethanol embolizations (range, 1-24; median, 3). Pulmonary artery pressure and arterial blood pressure were monitored as ethanol was injected. Ethanol embolizations (50%-100% ethanol mixed with nonionic contrast material) were performed by using transcatheter and/or direct puncture techniques. Ten patients underwent additional coil deployment during ethanol embolization. Clinical follow-up (range, 2-48 months; mean, 14.6 months; median, 12 months) was performed in all patients, and results from imaging follow-up (range, 0-48 months; mean, 8.4 months; median, 6 months) were available from the last treatment session in 28 patients. Therapeutic outcomes were established by evaluating the clinical outcome of symptoms and signs, as well as the degree of devascularization at follow-up angiography. RESULTS One hundred seventy-five ethanol embolizations were performed in 40 patients. Sixteen (40%) of 40 patients were cured, 11 (28%) had partial remission, seven (18%) had no remission, and one (2%) experienced aggravation. Treatment failed in five patients (12%). Ethanol embolization was considered effective (cure, 16 patients; partial remission, 11 patients) in 27 patients (68%). Eleven patients will need further treatment sessions for residual AVMs. Twenty-one patients (52%) experienced complications. Twenty-seven minor complications (skin and transient peripheral nerve injuries) (27 [15%] of 175 procedures) occurred in 18 (45%) of 40 patients. All minor complications were healed with wound dressing and observation. Five major complications (five [3%] of 175 procedures) occurred in five (12%) of 40 patients, and four patients recovered completely. CONCLUSION Ethanol embolization has the potential for cure in the management of AVMs of the body and extremities but with acceptable risk of minor and major complications.
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Affiliation(s)
- Young Soo Do
- Departments of Radiology, Surgery, Anesthesiology and Pain Medicine, and Internal Medicine, Cardiovascular Center, Samsung Medical Center and Sungkyunkwan University School of Medicine, Ilwon-Dong 50, Kangnam-Ku, Seoul 135-710, Korea
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