Embolization techniques for high-flow arteriovenous malformations with a dominant outflow vein

Conway, Alison; Drury, Jennifer; Rosen, Robert J.

doi:10.1016/j.jvsv.2014.12.003

Cited by 32 publications

(19 citation statements)

References 15 publications

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“…4 Although the usual target for embolization is the nutrient artery or nidus itself, recently successful treatment has been achieved with embolization of the draining vein. [29][30][31] Surgical excision of intraosseous AVMs offers the highest likelihood of cure; however, surgery can be quite morbid, especially in cases with extensive involvement, and may require future reconstruction of the residual defect. 11,19,32 In cases of small intraosseous AVMs, surgery alone has been successful in achieving complete resolution of symptoms.…”

Section: Discussionmentioning

confidence: 99%

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A Case of an Aggressive Intraosseous Arteriovenous Malformation in the Lower Extremity: Special Considerations for Diagnosis and Management

Stribling

Abu‐Ghname

Trost

et al. 2020

Vasc Endovascular Surg

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Background: Arteriovenous malformations (AVMs) are rare, congenital vascular anomalies. Intraosseous AVMS most frequently arise in the head and neck, with only a small fraction occurring in the extremities. Herein, we report the findings of a combined soft tissue and intraosseous AVM involving the lower extremity of a 13-year-old child. This case highlights the necessity of an interdisciplinary approach for the effective treatment and management of these rare vascular anomalies. Case Description: A 13-year-old female presented with a 4-year history of intermittent pain and swelling over her right lateral malleolus. The patient was evaluated with radiologic imaging revealing an AVM involving the right distal leg, ankle, and hindfoot with intraosseous involvement of the distal tibia and talus. She was then referred to Vascular and Plastic Surgery and an angiogram was performed demonstrating shunting from the anterior tibial, peroneal, and posterior tibial arteries to the AVM. Venous drainage was to the anterior tibial and greater saphenous veins. Three embolizations were performed over the course of 6 months. Following the third embolization, the patient was taken to the operating room where Plastic and Orthopedic Surgery performed total resection of the nidus and involved bone which was then grafted with injectable synthetic bone graft. Results: Successful resection of the nidus was achieved, and the patient had an uncomplicated recovery. Within 6 months postoperatively, the patient demonstrated full range of lower extremity motion and was able to participate in age appropriate gross motor activities. Radiologic evaluation 7 months postoperatively showed no evidence of nidus recurrence. Conclusion: Intraosseous involvement of AVMS is rare and presents a therapeutic challenge due to its invasive potential and high incidence of recurrence. Wide local excision with bone grafting and interdisciplinary management are paramount for complete resection.

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Section: Discussionmentioning

confidence: 99%

“…4 Although the usual target for embolization is the nutrient artery or nidus itself, recently successful treatment has been achieved with embolization of the draining vein. 29 -31…”

Section: Discussionmentioning

confidence: 99%

A Case of an Aggressive Intraosseous Arteriovenous Malformation in the Lower Extremity: Special Considerations for Diagnosis and Management

Stribling

Abu‐Ghname

Trost

et al. 2020

Vasc Endovascular Surg

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“…Therefore, familiarity with the unique angioarchitecture of the AVMdwhich can evolve between staged sessions of embolization mainly by recruitment of collateral arterial feeders and subsequent development of venous drainersdis essential in strategizing one's approach to embolization. 1,4,6,7,10 The Yakes AVM classification system provides a useful guide for treatment planning that may require retrograde and DSE primary treatment approaches (Table). 5,8,9,11 Whereas ultimately the route of therapy is determined by the experienced operator, certain AVM configurations lend themselves more effectively to certain therapeutic modalities over others.…”

Section: Discussionmentioning

confidence: 99%

Direct stick embolization of extremity arteriovenous malformations with ethylene vinyl alcohol copolymer

Nassiri

Cirillo-Penn

Crystal

2017

Journal of Vascular Surgery

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Direct stick embolization (DSE) of high-flow peripheral arteriovenous malformations (AVMs) has previously been reported using n-butyl cyanoacrylate and ethanol. The use of ethylene vinyl alcohol copolymer (Onyx; Covidien, Plymouth, Minn) through this delivery route has been extremely limited, particularly in the peripheral interventional realm, owing to concerns about technique and conduit for delivery, skin discoloration, and ulceration. We describe three patients with relatively focal, symptomatic, congenital high-flow AVMs of the upper and lower extremity treated successfully by multifaceted approaches including transvenous coil embolization of the nidus venous outflow, transarterial embolization, and DSE of the AVM nidus with Onyx. Successful delivery of Onyx into the AVM nidus was achieved without nontarget embolization. Sustained symptomatic relief without recurrence or associated complications was achieved at 1 month, 3 months, and 6 months of follow-up. Nidus embolization is a key technical maneuver for optimal treatment of high-flow AVMs, although it is not always easily achievable by the transarterial route in more extensive, convoluted angioarchitectural varieties. With appropriate technical considerations and precautionary measures, Onyx can be safely and effectively delivered through DSE into the AVM nidus with satisfactory short-term and midterm clinical outcomes. This maneuver expands the armamentarium of the treating vascular surgeon facing complicated peripheral AVMs.

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“…The goal for afference occlusion was to decrease the flow to the draining vein and perform a nidus embolization with low risk of nondesired distal embolization. 10,11 Despite the use of ethanol for endovascular ablation of AVM has been widely reported, 1,2,4 -16 we preferred thrombin for nidus occlusion, as we have more experience using this agent. The use of all embolization delivery routes is recommended for a more effective nidus destruction 1,8 (transarterial, transvenous, and direct puncture).…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of a Giant High-Flow Lower Limb Arteriovenous Malformation

Ramírez-Senent

Abadal

Vázquez

et al. 2017

Vasc Endovascular Surg

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Embolization techniques for high-flow arteriovenous malformations with a dominant outflow vein

Cited by 32 publications

References 15 publications

A Case of an Aggressive Intraosseous Arteriovenous Malformation in the Lower Extremity: Special Considerations for Diagnosis and Management

A Case of an Aggressive Intraosseous Arteriovenous Malformation in the Lower Extremity: Special Considerations for Diagnosis and Management

Direct stick embolization of extremity arteriovenous malformations with ethylene vinyl alcohol copolymer

Endovascular Management of a Giant High-Flow Lower Limb Arteriovenous Malformation

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