750. Serious Bacterial Infections: Successful Outpatient Management by Infectious Disease Physicians in Office Infusion Centers

Abstract Background Patients with serious bacterial infections (SBI), identified as bone and joint infections (BJI), bacteremia/endocarditis, and central nervous system (CNS) infections are frequently discharged on outpatient parenteral antimicrobial therapy (OPAT). They account for 48% of all infections treated in our network of Infectious Disease (ID) physician office infusion centers (POICs). Care for these patients poses risks and challenges to ensure safe and successful outcomes while avoiding hospitalizations. This study examines clinical outcomes and complications of our SBI patients receiving OPAT in ID POICs. Methods All patients were identified with SBI receiving OPAT in 2017 from 14 POICs. A group of 250 patients were randomly selected by incidence of diagnosis and a retrospective chart review performed. Demographics, treatment regimen, clinical outcomes, adverse drug reactions (ADRs) and unplanned hospitalizations during OPAT were collected. Clinical success was defined as clinical cure or improvement at completion of OPAT. Patients were included who were hospitalized for <7 days and subsequently completed OPAT. ADRs leading to hospitalization or discontinuation of OPAT were deemed serious. Descriptive statistics were used for distribution of variables. Results SBI patients included BJI (n = 175), bacteremia/endocarditis (n = 60) and CNS infections (n = 15) as described in Table 1. Successful clinical outcomes were reported in 224 patients (89.6%) after a mean duration of OPAT of 32±20 days. Of these, 15 patients (6.7%) were hospitalized during OPAT and returned to the POIC for a successful clinical outcome. Clinical success rates for BJI, bacteremia/endocarditis and CNS infections were 89.1%, 91.6% and 86.7%, respectively. The primary reason for nonfavorable outcomes was worsening of infection (15/26, 58%). Serious ADRs were reported in 12 patients (4.8%) with 6 (2.4%) leading to hospitalization. Unplanned hospitalizations during OPAT occurred in 33 patients (13.2%) with the majority (21/33, 64%) related to disease. ADRs and hospitalizations compare favorably to data previously reported. (Schmidt et al. OFID 16.4, 2017). Conclusion Patients with serious bacterial infections had high success rates when treated by an ID physician in infusion centers. Adverse events and unplanned hospitalization rates were low. Disclosures All authors: No reported disclosures.

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Evaluation of a thrice weekly administration of teicoplanin in the outpatient setting: a retrospective observational multicentre study

JAC-Antimicrobial Resistance ◽

10.1093/jacamr/dlab012 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

John Asumang ◽

Katie L Heard ◽

Oliver Troise ◽

Sandra Fahmy ◽

Nabeela Mughal ◽

...

Keyword(s):

Clinical Outcomes ◽

Clinical Success ◽

Serum Levels ◽

Service Evaluation ◽

Outpatient Setting ◽

Therapeutic Drug ◽

Success Rates ◽

Once Daily ◽

Outpatient Parenteral Antimicrobial Therapy ◽

L 14

Abstract Introduction The glycopeptide teicoplanin is commonly utilized to facilitate outpatient parenteral antimicrobial therapy (OPAT). Licensed for once daily maintenance dosing, teicoplanin’s long half-life allows for less frequent dosing (e.g. thrice weekly) following successful loading. This service evaluation reviews the safety and effectiveness of a novel thrice weekly teicoplanin dosing regimen. Methods A retrospective, observational study was conducted at Chelsea and Westminster Hospital (March 2018 to July 2020), evaluating trough serum teicoplanin concentrations for patients receiving >5 days of teicoplanin in the OPAT setting. Teicoplanin dosing and administration (once daily versus thrice weekly), clinical outcomes and therapeutic levels were analysed for all patients. The project was registered with clinical governance locally. Results A total of 82 patients treated with teicoplanin in the OPAT service were included; 53/82 receiving thrice weekly and 29/82 receiving once daily dosing. Mean teicoplanin trough levels were similar in both groups (26.2 mg/L and 25.8 mg/L in once daily and thrice weekly groups, P = 0.8895). High clinical success rates were recorded in both groups (25/29 [86.2%] versus 50/53 [94.3%]). No correlation with clinical outcomes and initial teicoplanin serum levels was identified. Normal renal function (>90 mL/min) was associated with lower teicoplanin serum concentrations (mean [±SD] 21.4 mg/L [±10.1] versus 29.7 mg/L [±14], P = 0.0178) in the thrice weekly dosed group but not with the once daily dosed group (mean [±SD] 28.2 mg/L [±9.4] versus 23.7 mg/L [±9.9], P = 0.2201). Conclusions This study supports thrice weekly teicoplanin as a convenient and effective OPAT for administration in the OPAT setting. Therapeutic drug monitoring is advised to adjust for intra-patient variability.

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1758. Impact of Accelerate Pheno™ Rapid Blood Culture Detection System on Laboratory and Clinical Outcomes in Bacteremic Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.143 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S61-S61 ◽

Cited By ~ 2

Author(s):

Ryan Dare ◽

Kelsey McCain ◽

Katherine Lusardi ◽

Kay Daniels ◽

Jacob Painter ◽

...

Keyword(s):

Blood Culture ◽

Clinical Outcomes ◽

Bacterial Infections ◽

Detection System ◽

Positive Culture ◽

Retrospective Chart Review ◽

Improve Patient Care ◽

Standard Of Care ◽

Historical Cohort ◽

Stewardship Program

Abstract Background Molecular-based automated systems for the rapid diagnosis of bacterial infections have potential to improve patient care. The Accelerate Pheno™ blood culture detection system (ACCEL) is an FDA approved platform that allows for identification (ID) and antimicrobial susceptibility testing (AST) 8 hours following growth in routine culture. Methods This is a single-center retrospective chart review of bacteremic adult inpatients before and after implementation of ACCEL. Laboratory and clinical data were collected February–March 2018 (intervention) and compared with a January–April 2017 historical cohort (standard of care). Standard of care ID and AST were performed using VITEK® MS (MALDI-TOF MS) and VITEK®2, respectively. An active antimicrobial stewardship program was in place during both study periods. Patients with polymicrobial cultures, off-panel isolates, previous positive culture, or who were discharged prior to final AST report were excluded. Primary outcome was length of stay (LOS). Secondary outcomes were inpatient antibiotic duration of therapy (DOT) and time to optimal therapy (TTOT). Nonparametric unadjusted analyses were performed due to non-normal distributions. Statistics were performed using SAS 9.4. Results Of the 143 positive cultures performed on ACCEL during intervention, 118 (83%) were identified as on-panel organisms. Seventy-five (64%) of these 118 cultures and 79 (70%) of 113 reviewed standard of care cultures met inclusion criteria. Patient comorbidities (P = NS), MEWS severity score (P = 0.10), source of bacteremia (P = NS), and pathogen detected (P = 0.30) were similar between cohorts. Time from collection to ID (28.2 ± 12.7 hours vs. 53.8 ± 20.9 hours; P < 0.001) and AST (31.9 ± 11 hours vs. 71.8 ± 20 hours; P < 0.001) were shorter in the intervention arm. Conclusion Compared with standard of care, ACCEL shortens laboratory turn-around-time and improves clinical outcomes. The use of this system has resulted in decreased mean antibiotic DOT, TTOT, and LOS. Further studies are needed to verify these findings. Disclosures All authors: No reported disclosures.

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Meropenem versus Cefuroxime plus Gentamicin for Treatment of Serious Infections in Elderly Patients

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.42.5.1233 ◽

1998 ◽

Vol 42 (5) ◽

pp. 1233-1238 ◽

Cited By ~ 19

Author(s):

C. A. J. J. Jaspers ◽

H. Kieft ◽

B. Speelberg ◽

A. Buiting ◽

M. van Marwijk Kooij ◽

...

Keyword(s):

Combination Therapy ◽

Elderly Patients ◽

Bacterial Infections ◽

Clinical Success ◽

Sepsis Syndrome ◽

Serious Infections ◽

Serious Bacterial Infections ◽

Satisfactory Clinical Response ◽

Intra Abdominal Infection ◽

Abdominal Infections

ABSTRACT In this multicenter study, the efficacy of and tolerability for meropenem were compared with those for the combination of cefuroxime-gentamicin (±metronidazole) for the treatment of serious bacterial infections in patients ≥65 years of age. A total of 79 patients were randomized; thirty-nine received meropenem (1 g/8 h), and 40 received cefuroxime (1.5 g/8 h) plus gentamicin (4 mg/kg of body weight daily) for 5 to 10 days. Metronidazole (500 mg/6 h) could be added to the cefuroxime-gentamicin regimen for the treatment of intra-abdominal infections (n = 10). Seventy patients were evaluable for clinical efficacy; the primary diagnoses were as follows: pneumonia in 41 patients (20 treated with meropenem, 21 treated with cefuroxime-gentamicin), intra-abdominal infection in 10 patients (7 meropenem, 3 cefuroxime-gentamicin-metronidazole), urinary tract infection (UTI) in 11 patients (6 meropenem, 5 cefuroxime-gentamicin), sepsis syndrome in 7 patients (4 meropenem, 3 cefuroxime-gentamicin), and “other” in 1 patient (cefuroxime-gentamicin). The pathogens isolated from 18 patients with bacteremia were as follows:Staphylococcus spp. (n = 2),Streptococcus spp. (n = 2), members of the family Enterobacteriaceae (n = 11), and Bacteroides spp. (n = 3). A satisfactory clinical response at the end of therapy was achieved in 26 of 37 (70%) and 24 of 33 (73%) evaluable patients treated with meropenem and combination therapy, respectively. Clinical success was achieved in 23 of 31 (74%) and 21 of 28 (75%) evaluable patients with infections other than UTIs, respectively. A satisfactory microbiological response occurred in 15 of 22 (68%) patients in the meropenem group compared with 12 of 19 (63%) treated with combination therapy. Renal failure occurred during therapy in 2 of 39 (5%) meropenem recipients compared with 5 of 40 (13%) of those treated with combination therapy. The findings in this small study indicate that meropenem is as efficacious for and as well tolerated by elderly patients as the combination of cefuroxime-gentamicin (±metronidazole).

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Promising results of stent graft placement for cephalic arch stenosis after repeated failure of angioplasty in patients on hemodialysis

Journal of International Medical Research ◽

10.1177/0300060520920419 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052092041

Author(s):

Pin-Chao Feng ◽

Chun-Hui Lee ◽

Hung-Chang Hsieh ◽

Po-Jen Ko ◽

Sheng-Yueh Yu ◽

...

Keyword(s):

Stent Graft ◽

Clinical Success ◽

Medical Center ◽

Retrospective Chart Review ◽

Target Lesion ◽

Primary Patency ◽

Secondary Patency ◽

Success Rates ◽

Graft Placement ◽

Significant Difference

Objective Cephalic arch stenosis (CAS) causes repeated dysfunction and failure of arteriovenous access. Percutaneous transluminal angioplasty is the standard initial treatment for CAS, but its outcome is unsatisfactory. This study aimed to evaluate the outcome of stent graft placement for CAS in patients on hemodialysis. Methods A retrospective chart review from a tertiary medical center was performed in patients receiving stent graft placement for CAS between January 2012 and 2016. Patency was analyzed using the Kaplan–Meier method. Results Twenty-one patients received stent graft placement for CAS. Technical and clinical success rates were 100%. Primary target lesion patency was 95% (95% confidence interval [CI], 86%–100%), 76% (95% CI, 58%–94%), and 43% (95% CI, 22%–64%) at 3, 6, and 12 months, respectively. No significant difference in patency was observed between the arteriovenous fistula and arteriovenous graft groups. Assisted primary patency was 95% (95% CI, 86%–100%), 71% (95% CI, 52%–91%), and 57% (95% CI, 36%–78%) at 3, 6, and 12 months, respectively. Secondary patency was 100% at 3, 6, and 12 months. Conclusions After repeated failed angioplasty for cephalic arch stenosis, patients on hemodialysis who receive stent graft placement have effective and durable outcomes.

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PREVALENCE OF SERIOUS BACTERIAL INFECTIONS IN CHILDREN WITH SICKLE CELL DISEASE AT KING ABDULAZIZ HOSPITAL, AL AHSA

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2021.002 ◽

2020 ◽

Vol 13 (1) ◽

pp. e2021002

Author(s):

Manal Alsaif ◽

Joan Robinson ◽

Moshtag Abdulbaqi ◽

Mustafa Aghbari ◽

Khalid Al Noaim ◽

...

Keyword(s):

Saudi Arabia ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Bacterial Infections ◽

Chart Review ◽

Retrospective Chart Review ◽

Outpatient Management ◽

Cell Disease ◽

Apparent Source ◽

Serious Bacterial Infections

Aim: The main aim was to report the prevalence and severity of serious bacterial infections (SBI) in children with sickle cell disease at King Abdulaziz Hospital, Al Ahsa, Saudi Arabia to aid in determining whether outpatient management of such cases is appropriate. Methods: We conducted a retrospective chart review of febrile children less than 14 years of age admitted with sickle cell disease 2005 through 2015. Results: During 320 admissions, 25 children had SBIs (8%) including pneumonia (n=11), osteomyelitis (n=8), bacteremia (n=3, all with Salmonella species) and UTI (n=3). All recovered uneventfully. Conclusion: It appears that in the current era, less than 10% of febrile children with sickle cell disease in our center are diagnosed with a SBI. Over an 11-year period, there were no sequelae or deaths from SBI. Given these excellent outcomes, outpatient ceftriaxone should be considered for febrile well appearing children with sickle cell disease if they have no apparent source and parents are judged to be reliable.

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126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.436 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S192-S193

Author(s):

Brett Young ◽

Scott Bergman ◽

Trevor C Van Schooneveld ◽

Nicolas W Cortes-Penfield ◽

Bryan Alexander

Keyword(s):

Infectious Disease ◽

Clinical Outcomes ◽

Antimicrobial Therapy ◽

Hospital Readmission ◽

Academic Medical Center ◽

Transitions Of Care ◽

Day Hospital ◽

Consult Service ◽

Outpatient Parenteral Antimicrobial Therapy ◽

The Impact

Abstract Background Our large academic medical center initiated both an Outpatient Parenteral Antimicrobial Therapy (OPAT) program supported by an infectious disease trained pharmacist, along with an Orthopedic Infectious Disease (OID) consult service to assist in caring for these specialized populations. We measured the impact of these services. Methods Patients discharged on parenteral antimicrobial therapy were divided into two groups. The pre-OPAT cohort included all patient receiving OPAT from 4/1/18 - 10/31/18; the post-OPAT cohort included all patients who received OPAT from 4/1/19 - 10/31/19 with OPAT consult (Fig 1). The OID consult service began in September 2018 prior to initiation of the OPAT program. The primary outcome was 30-day hospital readmission. Secondary outcomes included: length of stay (LOS), 90-day readmission, clinical outcomes, and identification of predictors of hospital readmission. Clinical outcomes included: time from final OR visit to discharge for OID patients and optimal treatment (cefazolin, oxacillin, or nafcillin) for MSSA. Results Introduction of these programs was associated with a reduction in all-cause 30-day readmission from 39.3% to 22.9%, and a reduction in 30-day readmission for patients on-treatment from 24.6% to 15.6% (p< 0.01 for both). No difference was seen in hospital LOS (8 days in each cohort). In a subgroup analysis (Fig 2), OID patients in the post-OPAT cohort saw a median reduction of 2 days (7 days to 5 days, p=0.002) in time from final OR visit to discharge. Use of optimal treatments for MSSA increased in the post-OPAT cohort compared to pre-OPAT (65.2% to 80.9%; p=0.06). The 90-day hospital readmission rate were higher in the post-OPAT cohort among patients who lived in metro-area zip codes (p=0.03). Having an established primary care physician was associated with lower 90-day hospital readmission in both the pre-and post-OPAT cohorts (p=0.05 and 0.01, respectively). Conclusion Thirty-day readmission rates among patients discharged on OPAT significantly lowered following initiation of a combination of both a pharmacist-led OPAT program and OID consult service. OPAT and OID programs accrue additional efficiencies and clinical benefits to both patients and hospitals, which can be further evaluated and used to justify such service additions. Disclosures All Authors: No reported disclosures

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Real-world Multicenter Analysis of Clinical Outcomes and Safety of Meropenem-Vaborbactam in Patients Treated for Serious Gram-Negative Bacterial Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa051 ◽

2020 ◽

Vol 7 (3) ◽

Cited By ~ 5

Author(s):

Sara Alosaimy ◽

Sarah C J Jorgensen ◽

Abdalhamid M Lagnf ◽

Sarah Melvin ◽

Ryan P Mynatt ◽

...

Keyword(s):

Clinical Outcomes ◽

Real World ◽

Bacterial Infections ◽

Clinical Success ◽

Gram Negative ◽

Carbapenem Resistant ◽

Multicenter Analysis ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Fourty patients were treated with meropenem-vaborbactam (MEV) for serious Gram-negative bacterial (GNB) infections. Carbapenem-resistant Enterobacteriaceae (CRE) comprised 80.0% of all GNB infections. Clinical success occurred in 70.0% of patients. Mortality and recurrence at 30 days were 7.5% and 12.5%, respectively. One patient experienced a probable rash due to MEV.

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Impact of peritoneal carcinomatosis on clinical outcomes of patients receiving self-expandable metal stents for malignant colorectal obstruction

Endoscopy ◽

10.1055/a-0657-3764 ◽

2018 ◽

Vol 50 (12) ◽

pp. 1163-1174 ◽

Cited By ~ 3

Author(s):

Jae Park ◽

Kwangwon Rhee ◽

Jin Yoon ◽

Soo Park ◽

Joo Kim ◽

...

Keyword(s):

Peritoneal Carcinomatosis ◽

Success Rate ◽

Clinical Outcomes ◽

Clinical Success ◽

Clinical Success Rate ◽

Metal Stents ◽

Independent Factor ◽

Success Rates ◽

Colorectal Obstruction ◽

Technical Success Rate

Abstract Background Peritoneal carcinomatosis can influence clinical outcomes of patients receiving self-expandable metal stents (SEMS) for malignant colorectal obstruction, but data regarding this issue are sparse. We analyzed the clinical outcomes of post-SEMS insertion for malignant colorectal obstruction based on carcinomatosis status. Methods Stent- and patient-related clinical outcomes were compared for carcinomatosis status in a retrospective review involving 323 consecutive patients (colorectal cancer 198 patients; extracolonic malignancy 125 patients) who underwent palliative SEMS placement for malignant colorectal obstruction from January 2005 to March 2012. Severity of carcinomatosis was classified as mild, moderate, or severe. Results Carcinomatosis was observed in 190 patients (58.8 %). The rates of technical (84.7 vs. 94.7 %; P = 0.005) and clinical (73.2 vs. 83.5 %; P = 0.03) success were lower in patients with vs. without carcinomatosis. Rates of early (2.1 % vs. 3.0 %; P = 0.72) and delayed (1.6 % vs. 6.0 %; P = 0.08) perforation and stent failure (27.9 % vs. 26.3 %; P = 0.75) showed no difference. Technical and clinical success rates were significantly different based on the severity of carcinomatosis (technical success rate: mild 90.7 %, moderate 97.4 %, severe 76.3 %, P = 0.003; clinical success rate: mild 83.3 %, moderate 82.1 %, severe 63.9 %, P = 0.01). In multivariate analysis, severe carcinomatosis was identified as an independent factor related to technical (odds ratio [OR] 0.18, 95 % confidence interval [CI] 0.06 – 0.56) and clinical (OR 0.33, 95 %CI 0.15 – 0.74) success. Conclusions Peritoneal carcinomatosis was associated with decreased technical and clinical success rates in patients receiving SEMS for malignant colorectal obstruction. Moreover, the presence of severe carcinomatosis was an independent factor determining these clinical outcomes.

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National Survey of Thai Infectious Disease Physicians on Treatment of Carbapenem-ResistantAcinetobacter baumanniiVentilator-Associated Pneumonia: The Role of Infection Control Awareness

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.240 ◽

2015 ◽

Vol 37 (1) ◽

pp. 61-69 ◽

Cited By ~ 3

Author(s):

Aubonphan Buppajarntham ◽

Anucha Apisarnthanarak ◽

Thana Khawcharoenporn ◽

Sasinuch Rutjanawech ◽

Nalini Singh

Keyword(s):

Infectious Disease ◽

Infection Control ◽

Clinical Response ◽

Success Rate ◽

Clinical Success ◽

Treatment Success ◽

Clinical Success Rate ◽

Success Rates ◽

Case Scenario ◽

Carbapenem Resistant

OBJECTIVETo evaluate the expected and treatment outcomes of Thai infectious disease physicians (IDPs) regarding carbapenem-resistantAcinetobacter baumannii(CRAB) ventilator-associated pneumonia (VAP)METHODSFrom June 1, 2014, to March 1, 2015, survey data regarding the expected and clinical success rates of CRAB VAP treatment were collected from all Thai IDPs. The expected success rate was defined as the expectation of clinical response after CRAB VAP treatment for the given case scenario. Clinical success rate was defined as the overall reported success rate of CRAB VAP treatment based on the clinical practice of each IDP. The expected and clinical success rates were divided into low (<60%), standard (60%–80%), and high (>80%) categories and were then compared with standard clinical response rates archived in the existing literature.RESULTSOf 183 total Thai IDPs, 111 (60%) were enrolled in this study. The median expected and clinical success rates were 68% and 58%, respectively. Using multivariate analysis, we determined that working in a hospital that implemented the standard intervention combined with an intensified infection control (IC) intervention for CRAB (adjusted odds ratio [aOR], 3.01; 95% confidence interval [CI], 1.17–7.73;P=.02) was associated with standard and high expected rates (>60%). Being a board-certified IDP (aOR, 5.76; 95% CI, 2.16–15.37;P<.01) and having higher number of ID consultation cases per month (aOR, 4.84; 95% CI, 1.98–11.80;P<.01) were associated with standard and high clinical success rates (>60%). We identified a significant correlation between expected and clinical success rates (r=0.58;P<.001).CONCLUSIONSAwareness of IC among IDPs can improve physicians’ expected and clinical success rates for CRAB VAP treatment, and treatment experience impacts overall treatment success.Infect. Control Hosp. Epidemiol.2015;37(1):61–69

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Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer - feasibility, technical outcomes, and clinical outcomes

VASA ◽

10.1024/0301-1526/a000571 ◽

2016 ◽

Vol 45 (6) ◽

pp. 497-504 ◽

Cited By ~ 11

Author(s):

Tom De Beule ◽

Jan Vranckx ◽

Peter Verhamme ◽

Veerle Labarque ◽

Marie-Anne Morren ◽

...

Keyword(s):

Clinical Outcomes ◽

Clinical Improvement ◽

Arteriovenous Malformations ◽

Clinical Success ◽

Transarterial Embolization ◽

Recurrent Bleeding ◽

Complete Disappearance ◽

Ethylene Vinyl Alcohol ◽

Initial Symptoms

Abstract. Background: The technical and clinical outcomes of catheter-directed embolization for peripheral arteriovenous malformations (AVM) using Onyx® (ethylene-vinyl alcohol copolymer) are not well documented. The purpose of this study was to retrospectively assess the safety, technical outcomes and clinical outcomes of catheter-directed Onyx® embolisation for the treatment of symptomatic peripheral AVMs. Patients and methods: Demographics, (pre-)interventional clinical and radiological data were assessed. Follow-up was based on hospital medical records and telephone calls to the patients’ general practitioners. Radiological success was defined as complete angiographic eradication of the peripheral AVM nidus. Clinical success was defined as major clinical improvement or complete disappearance of the initial symptoms. Results: 25 procedures were performed in 22 patients. The principal indications for treatment were pain (n = 10), limb swelling (n = 6), recurrent bleeding (n = 2), tinnitus (n = 3), and exertional dyspnoea (n = 1). Complete radiological success was obtained in eight patients (36 %); near-complete eradication of the nidus was achieved in the remaining 14 patients. Adjunctive embolic agents were used in nine patients (41 %). Clinical success was observed in 18 patients (82%). Major complications were reported in two patients (9 %). During follow-up, seven patients (32 %) presented with symptom recurrence, which required additional therapy in three patients. Conclusions: Catheter-directed embolisation of peripheral AVMs with Onyx® resulted in major clinical improvement or complete disappearance of symptoms in the vast majority of patients, although complete angiographic exclusion of the AVMs occurred in only a minority of patients.

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