The use of dual-lumen balloon for embolization of peripheral arteriovenous malformations

Albuquerque, Tales Vieira Cavalcanti; Stamoulis, Dimitrius Nikolaos Jaconi; Monsignore, Lucas Moretti; Castro-Afonso, Luís Henrique de; Nakiri, Guilherme Seizem; Rezende, Marco Túlio Salles; Trivelato, Felipe Padovani; Vanzin, José Ricardo; Ulhôa, Alexandre Cordeiro; Abud, Daniel Giansante

doi:10.5152/dir.2021.19628

Cited by 5 publications

(7 citation statements)

References 35 publications

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“…Complete devascularization was obtained in the most cases (58%) including the 12 patients with subsequential surgical resection. These results are similar to previously published studies of embolotherapy of extracranial AVMs [6,17,18], though there has to be noted that in our cohort a higher percentage received subsequent surgical resection (41%). While using EVOH-based liquid agents in most procedures we found an overall and major complication rate of 24% and 18%, respectively.…”

Section: Discussionsupporting

confidence: 93%

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Schmidt

Masthoff

Brill

et al. 2022

Cardiovasc Intervent Radiol

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Purpose To evaluate the safety and outcome of image-guided embolotherapy of extracranial arteriovenous malformations (AVMs) primarily affecting the face. Materials and Methods A multicenter cohort of 28 patients presenting with AVMs primarily affecting the face was retrospectively investigated. Fifty image-guided embolotherapies were performed, mostly using ethylene–vinyl alcohol copolymer-based embolic agents. Clinical and imaging findings were assessed to evaluate response during follow-up (symptom-free, partial relief of symptoms, no improvement, and progression despite embolization), lesion devascularization (total, 100%; substantial, 76–99%; partial, 51–75%; failure, < 50%; and progression), and complication rates (classified according to the CIRSE guidelines). Sub-analyses regarding clinical outcome (n = 24) were performed comparing patients with (n = 12) or without (n = 12) subsequent surgical resection after embolotherapy. Results The median number of embolotherapy sessions was 2.0 (range, 1–4). Clinical outcome after a mean follow-up of 12.4 months (± 13.3; n = 24) revealed a therapy response in 21/24 patients (87.5%). Imaging showed total devascularization in 14/24 patients (58.3%), including the 12 patients with subsequent surgery and 2 additional patients with embolotherapy only. Substantial devascularization (76–99%) was assessed in 7/24 patients (29.2%), and partial devascularization (51–75%) in 3/24 patients (12.5%). Complications occurred during/after 12/50 procedures (24.0%), including 18.0% major complications. Patients with subsequent surgical resections were more often symptom-free at the last follow-up compared to the group having undergone embolotherapy only (p = 0.006). Conclusion Image-guided embolotherapy is safe and effective for treating extracranial AVMs of the face. Subsequent surgical resections after embolization may substantially improve patients’ clinical outcome, emphasizing the need for multimodal therapeutic concepts. Level of Evidence Level 4, Retrospective study.

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Section: Discussionsupporting

confidence: 93%

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Schmidt

Masthoff

Brill

et al. 2022

Cardiovasc Intervent Radiol

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“…This constitutes a low rate compared to 63% or 79% of complete devascularization of peripheral AVMs in other parts of the body. 25,33 In studies of hand AVMs, similar results have been obtained. Park et al reported total obliteration of AVM vessels with ethanol in just 1 case of the entire cohort (3%).…”

Section: Discussionsupporting

confidence: 66%

“…Hereof, 6 events occurred periprocedurally including 1 embolic stroke. 25 Albuquerque et al 33 recently assessed an overall complication rate of 16% in a retrospective study of 25 EVOH embolotherapies of peripheral AVMs in 14 patients while 3 patients presented with skin necrosis and 1 patient with a periprocedural small focus of active bleeding. In general, the safety in the present study is comparable to the previously mentioned studies on embolization using EVOH.…”

Section: Discussionmentioning

confidence: 99%

Image-guided embolization of arteriovenous malformations of the hand using Ethylene-vinyl Alcohol Copolymer

Schmidt

Masthoff

Goldann

et al. 2022

Diagn Interv Radiol

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“…Non-adhesive Liquid Embolic Agents are a useful tool in cases of AVM embolization because they harden from the outside to inside; this characteristic allows a deep penetration, known as “magma-like” progression. Non-adhesive Liquid Embolic Agents are nowadays considered the first-line embolic agent for AVM in the central nervous system with higher rates of complete nidus embolization while their use has been extended for peripheral AVM with acceptable safety and effectiveness [ 29 ].…”

Section: Arterio-venous Malformationmentioning

confidence: 99%

“…In the literature, one of the most recent papers with the largest and most heterogeneous case series (14 patients) of extracranial AVM embolization was written by Albuquerque et al [ 29 ], which describes the use of non-adhesive embolizing fluid combined with the use of dual-lumen balloon as an innovative approach associated with excellent clinical results and a low risk of complications, reducing the risk of embolic liquid reflux. A large arteriovenous malformation (AVM) of the pancreatic head with arterial feedings from superior and inferior PDA and anomalous communication with portal vein was embolized using Onyx (3 mL) as described by Grasso et al in their case report, representing a valid and successful alternative to surgery [ 33 ], as reported for AVM causing recurrent pancreatitis and the development of a pancreatic cephalic pseudocyst with hemorrhagic content, successfully treated through embolization of arterial afferents arising from the inferior PDA, gastroduodenal artery, and dorsal pancreatic artery [ 34 ].…”

Section: Arterio-venous Malformationmentioning

confidence: 99%

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

Piacentino

Fontana

Curti

et al. 2021

JCM

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This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been published recently and the aim of this review is to explore and analyze this field of application. There are a few NALEA liquids such as Onyx, Squid, and Phil currently available in the market, and they are used in the following applications: mainly arteriovenous malformations, endoleaks, visceral aneurysm or pseudoaneurysm, presurgical and hypervascular lesions embolization, and a niche of percutaneous approaches. These types of embolizing fluids can be used alone or in combination with other embolizing agents (such as coils or particles) so as to enhance its embolizing effect or improve its possible defects. The primary purpose of this paper is to evaluate the use of NALEAs, predominantly used alone, in elective embolization procedures. We did not attempt a meta-analysis due to the data heterogeneity, high number of case reports, and the lack of a consistent follow-up time period.

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The use of dual-lumen balloon for embolization of peripheral arteriovenous malformations

Cited by 5 publications

References 35 publications

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Image-guided embolization of arteriovenous malformations of the hand using Ethylene-vinyl Alcohol Copolymer

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

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