scholarly journals Transvenous embolization of brain arteriovenous malformations: a review of techniques, indications, and outcomes

2018 ◽  
Vol 45 (1) ◽  
pp. E13 ◽  
Author(s):  
Ching-Jen Chen ◽  
Pedro Norat ◽  
Dale Ding ◽  
George A. C. Mendes ◽  
Petr Tvrdik ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Small Diameter ◽  
Endovascular Embolization ◽  
Complication Rates ◽  
Transvenous Embolization ◽  
Efficacy And Safety ◽  
Brain Arteriovenous Malformations ◽  
Complete Obliteration ◽  
Transvenous Approach ◽  
Technical Considerations

Endovascular embolization of brain arteriovenous malformations (AVMs) is conventionally performed from a transarterial approach. Transarterial AVM embolization can be a standalone treatment or, more commonly, used as a neoadjuvant therapy prior to microsurgery or stereotactic radiosurgery. In contrast to the transarterial approach, curative embolization of AVMs may be more readily achieved from a transvenous approach. Transvenous embolization is considered a salvage therapy in contemporary AVM management. Proposed indications for this approach include a small (diameter < 3 cm) and compact AVM nidus, deep AVM location, hemorrhagic presentation, single draining vein, lack of an accessible arterial pedicle, exclusive arterial supply by perforators, and en passage feeding arteries. Available studies of transvenous AVM embolization in the literature have reported high complete obliteration rates, with reasonably low complication rates. However, evaluating the efficacy and safety of this approach is challenging due to the limited number of published cases. In this review the authors describe the technical considerations, indications, and outcomes of transvenous AVM embolization.

Embolization of brain arteriovenous malformations with intent to cure: a systematic review

2020 ◽  
Vol 132 (2) ◽  
pp. 388-399 ◽  
Author(s):  
Eva M. Wu ◽  
Tarek Y. El Ahmadieh ◽  
Cameron M. McDougall ◽  
Salah G. Aoun ◽  
Nikhil Mehta ◽  
...  
Keyword(s):  
Complication Rate ◽  
Treatment Strategy ◽  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Definitive Treatment ◽  
Complication Rates ◽  
Brain Arteriovenous Malformations ◽  
Complete Obliteration ◽  
Complete Treatment ◽  
Entire Patient Cohort

OBJECTIVEEndovascular embolization has been established as an adjuvant treatment strategy for brain arteriovenous malformations (AVMs). A growing body of literature has discussed curative embolization for select lesions. The transition of endovascular embolization from an adjunctive to a definitive treatment modality remains controversial. Here, the authors reviewed the literature to assess the lesional characteristics, technical factors, and angiographic and clinical outcomes of endovascular embolization of AVMs with intent to cure.METHODSElectronic databases—Ovid MEDLINE, Ovid Embase, and PubMed—were searched for studies in which there was evidence of AVMs treated using endovascular embolization with intent to cure. The primary outcomes of interest were angiographic obliteration immediately postembolization and at follow-up. The secondary outcomes of interest were complication rates. Descriptive statistics were used to calculate rates and means.RESULTSFifteen studies with 597 patients and 598 AVMs treated with intent-to-cure embolization were included in this analysis. Thirty-four percent of AVMs were Spetzler-Martin grade III. Complete obliteration immediately postembolization was reported in 58.3% of AVMs that had complete treatment and in 45.8% of AVMs in the entire patient cohort. The overall clinical complication rate was 24.1%. The most common complication was hemorrhage, occurring in 9.7% of patients. Procedure-related mortality was 1.5%.CONCLUSIONSWhile endovascular embolization with intent to cure can be an option for select AVMs, the reported complication rates appear to be increased compared with those in studies in which adjunctive embolization was the goal. Given the high complication rate related to a primary embolization approach, the risks and benefits of such a treatment strategy should be discussed among a multidisciplinary team. Curative embolization of AVMs should be considered an unanticipated benefit of such therapy rather than a goal.

scholarly journals Selective arterial temporary flow arrest with balloons during transvenous embolization for the treatment of brain arteriovenous malformations: a feasibility study with MRI-monitored adverse events

2022 ◽  
pp. neurintsurg-2021-018097
Author(s):  
Christina Iosif ◽  
Jose Alberto Almeida Filho ◽  
Clara Esther Gilbert ◽  
Ali Nazemi Rafie ◽  
Suzana Saleme ◽  
...  
Keyword(s):  
Adverse Events ◽  
Feasibility Study ◽  
Arteriovenous Malformations ◽  
Brain Mri ◽  
Endovascular Embolization ◽  
Transvenous Embolization ◽  
Total Occlusion ◽  
Brain Arteriovenous Malformations ◽  
Clinically Significant ◽  
Transvenous Approach

BackgroundThe technique of endovascular transvenous embolization for brain arteriovenous malformations (AVMs) has emerged in the last 8 years as a very promising therapeutic alternative for otherwise incurable cases. Selective temporary flow arrest during transvenous endovascular embolization (TFATVE) is a novel adaptation of our previously described transvenous approach, which employs hyper-compliant balloons intra-arterially for the selective occlusion of arterial feeders during ethylene vinyl copolymer (EVOH) injection, in order to reduce intra-nidal pressure and increase nidi occlusion rates.MethodsWe performed a feasibility study of the TFATVE technique between January 2016 and April 2020. Consecutive patients were included. All patients had at least one axial brain MRI or CT in the first 48 hours following intervention, and at least one brain MRI scan within the first postoperative month, in order to detect both silent and clinically evident adverse events. Patients’ demographics, angio-architectural characteristics, total injection and procedure times, angiographic and clinical outcomes were analyzed.Results22 patients underwent TFATVE during transvenous endovascular treatment of brain AVMs. Among them, 86.4% were high Spetzler-Martin’s grade. Good clinical outcome (modified Rankin Scale <2) was achieved in 95.5% of the cases, with 0% of procedure-related mortality and 4.5% of clinically significant, procedure-related morbidity. Total occlusion of the nidus was achieved in >90% of the cases at the end of the procedure and angiographic stability was achieved in all cases; 100% of the cases had angiographic cure at follow-up.ConclusionsTFATVE seems a safe and effective technique when conducted in carefully selected patients in highly specialized centers.

Transvenous embolization: a report of 4 pediatric cases

2015 ◽  
Vol 15 (4) ◽  
pp. 445-450 ◽  
Author(s):  
Leonardo Renieri ◽  
Nicola Limbucci ◽  
Arturo Consoli ◽  
Andrea Rosi ◽  
Sergio Nappini ◽  
...  
Keyword(s):  
Side Effects ◽  
Arteriovenous Malformations ◽  
Therapeutic Option ◽  
Endovascular Embolization ◽  
Transvenous Embolization ◽  
Promising Alternative ◽  
Complete Occlusion ◽  
Arterial Access ◽  
Drainage Vein ◽  
Transvenous Approach

The treatment of brain arteriovenous malformations (AVMs) in children has always been a challenge for interventionalists, neurosurgeons, and radiosurgeons. Endovascular embolization is usually performed through transarterial access, but in selected cases the transvenous approach can be considered. The authors of this report aimed to evaluate the efficacy of transvenous embolization in very selected pediatric cases. They describe 4 children treated using transvenous embolization for AVMs that were small, had a single drainage vein, and were deeply located or had a difficult arterial access. The 6-month angiographic and clinical follow-ups are reported as well. In all cases, complete occlusion of the AVM was achieved with no side effects for the patient. Transvenous embolization may represent a promising alternative therapeutic option in very selected cases.

Successful Transvenous Embolization of Brain Arteriovenous Malformations Using Onyx in Five Consecutive Patients

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. 184-193 ◽  
Author(s):  
Iruena Kessler ◽  
Roberto Riva ◽  
Maria Ruggiero ◽  
Monica Manisor ◽  
Maher Al-Khawaldeh ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Interventional Neuroradiology ◽  
Endovascular Embolization ◽  
Term Treatment ◽  
University Hospital ◽  
Modified Rankin Scale ◽  
Safe Alternative ◽  
Ethylene Vinyl Alcohol ◽  
Brain Arteriovenous Malformations ◽  
Transvenous Approach

Abstract BACKGROUND: There is an increasing application of endovascular treatment for brain arteriovenous malformations (BAVMs) using ethylene vinyl alcohol copolymer (Onyx). Historically, this treatment has been performed using a transarterial approach. OBJECTIVE: To report our experience with transvenous endovascular embolization with Onyx (TVEO). METHODS: Five consecutive patients with BAVMs underwent endovascular TVEO between June 2007 and March 2009 at the Interventional Neuroradiology Department of the University Hospital of Limoges. There were 3 men and 2 women with a mean age of 41.8 years (range, 19-57 years). The clinical presentation included symptoms caused by intracerebral hemorrhage (n = 4) and seizures (n = 1). According to the Spetzler-Martin classification scheme, 3 BAVMs (60%) were grade III, and 2 BAVMs (40%) were grade IV. Four BAVMs (80%) were supratentorial and 1 BAVM (20%) was infratentorial. Immediate and mid-term treatment (6 months) outcomes were angiographically and clinically analyzed according to the modified Rankin Scale. RESULTS: The transvenous approach was used in all patients (100%). The success rate of complete obliteration of the arteriovenous malformation nidus was 80% (4 of 5), confirmed by follow-up angiography performed immediately and at 6 months after TVEO. No procedure-related complications occurred during or after embolization. All patients remained unchanged (modified Rankin Scale score = 0–2) and clinically stable 6 months after TVEO. CONCLUSION: The transvenous approach using Onyx for the management of BAVMs is shown to be an efficient and safe alternative treatment in cases with no other conventional therapeutic choice and when some anatomic considerations are respected.

Adenosine-induced transient circulatory arrest in transvenous embolization of cerebral arteriovenous malformations

2021 ◽  
pp. 197140092199897
Author(s):  
Mohammad Ghorbani ◽  
Christoph J Griessenauer ◽  
Christoph Wipplinger ◽  
Pascal Jabbour ◽  
Mahdi Kadkhodazadeh Asl ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Circulatory Arrest ◽  
Standard Procedure ◽  
Endovascular Embolization ◽  
Transvenous Embolization ◽  
Effective Treatment Option ◽  
Specific Subset ◽  
Ensure Patient Safety ◽  
Cerebrovascular Surgery ◽  
Transvenous Approach

Due to advances in interventional techniques, the transvenous approach may present an effective treatment option for embolization of brain arteriovenous malformations (AVMs). Contrary to the transarterial method, the transvenous approach can only be utilized in a specific subset of patients and is not suitable as a standard procedure for all AVM lesions. While this technique can be helpful in certain patients, careful patient selection to ensure patient safety and favorable clinical outcomes is important. However, especially in high-flow AVMs, targeted deposition of embolic materials through a transvenous access can be challenging. Therefore, a temporary flow arrest may prove helpful. Transient cardiac arrest by use of adenosine has been applied in cerebrovascular surgery but is not common for endovascular embolization. Adenosine-induced arrest and systemic hypotension may be a feasible, safe method to reduce flow and help endovascular transvenous embolization of certain AVMs. Our study evaluated the efficiency and safety of adenosine-induced circulatory arrest for transvenous embolization of cerebral AVMs.

Curative endovascular treatment for low-grade Spetzler-Martin brain arteriovenous malformations: a single-center prospective study

2019 ◽  
Vol 11 (7) ◽  
pp. 699-705 ◽  
Author(s):  
Christina Iosif ◽  
Adson Freitas de Lucena ◽  
Luiz Gustavo Abreu-Mattos ◽  
Victor Hugo Espindola Ala ◽  
Amin El-Ghanam ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Malformations ◽  
Venous Access ◽  
Clinical Results ◽  
Low Grade ◽  
Complication Rates ◽  
Single Center ◽  
Brain Arteriovenous Malformations ◽  
Complete Obliteration ◽  
Brain Avms

BackgroundThe treatment of low grade Spetzler-Martin (SM) brain arteriovenous malformations (AVMs) has been debated in unruptured cases. Nevertheless, in clinical practice there are cases where treatment is preferred; in these cases a very low complication rate is mandatory. In ruptured cases, early and complete obliteration of the nidus is the preferred strategy.ObjectiveTo achieve curative embolization, ideally in a single session, by dual microcatheterization techniques with arterial and/or venous access, according to the angioarchitecture.Materials and methodsThis is a prospective, single-center study carried out between January 2008 and January 2016. Patients with ruptured and unruptured brain AVMs, with SM grades I and II, treated by endovascular means, were included. Demographics, clinical presentation, angioarchitecture, and procedure-related complications were analyzed. Angiographic and clinical results were reported.ResultsSeventy-three patients, aged 40.5±17.8 years, were included. More than 60% of the patients presented with ruptured AVMs. Initial SM grades were I for 22% and II for 78% of the patients. Preprocedural modified Rankin Scale (mRS) score was 0–2 for 53 (72.6%), 3 for 12 (16.4%), 4 for 5 (6.8%) and 5 for 3 (4.1%) patients. Procedure-related morbidity was 2.7% and procedure-related mortality was 0%. Ninety percent (90.5%) of the patients were independent in their everyday lives (mRS score 0–2) at 6 months. In all but one case (95%) the embolization was curative.ConclusionStand-alone endovascular treatment for SM grade I and II brain AVMs seems safe and effective, allowing for complete obliteration of the nidus, with low complication rates. A study of larger cohorts is needed.

scholarly journals Microsurgery for cerebral arteriovenous malformations: postoperative outcomes and predictors of complications in 264 cases

2014 ◽  
Vol 37 (3) ◽  
pp. E10 ◽  
Author(s):  
Thana Theofanis ◽  
Nohra Chalouhi ◽  
Richard Dalyai ◽  
Robert M. Starke ◽  
Pascal Jabbour ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Presentation ◽  
High Volume ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Complete Obliteration ◽  
Grade Ii ◽  
Microsurgical Resection

Object The authors conducted a study to assess the safety and efficacy of microsurgical resection of arteriovenous malformations (AVMs) and determine predictors of complications. Methods A total of 264 patients with cerebral AVMs were treated with microsurgical resection between 1994 and 2010 at the Jefferson Hospital for Neuroscience. A review of patient data was performed, including initial hemorrhage, clinical presentation, Spetzler-Martin (SM) grade, treatment modalities, clinical outcomes, and obliteration rates. Univariate and multivariate analyses were used to determine predictors of operative complications. Results Of the 264 patients treated with microsurgery, 120 (45%) patients initially presented with hemorrhage. There were 27 SM Grade I lesions (10.2%), 101 Grade II lesions (38.3%), 96 Grade III lesions (36.4%), 31 Grade IV lesions (11.7%), and 9 Grade V lesions (3.4%). Among these patients, 102 (38.6%) had undergone prior endovascular embolization. In all patients, resection resulted in complete obliteration of the AVM. Complications occurred in 19 (7.2%) patients and resulted in permanent neurological deficits in 5 (1.9%). In multivariate analysis, predictors of complications were increasing AVM size (OR 3.2, 95% CI 1.5–6.6; p = 0.001), increasing number of embolizations (OR 1.6, 95% CI 1.1–2.2; p = 0.01), and unruptured AVMs (OR 2.7, 95% CI 1–7.2; p = 0.05). Conclusions Microsurgical resection of AVMs is highly efficient and can be undertaken with low rates of morbidity at high-volume neurovascular centers. Unruptured and larger AVMs were associated with higher complication rates.

Nidal embolization of brain arteriovenous malformations: rates of cure, partial embolization, and clinical outcome

2012 ◽  
Vol 117 (1) ◽  
pp. 65-77 ◽  
Author(s):  
Daniel H. Sahlein ◽  
Paloma Mora ◽  
Tibor Becske ◽  
Peter K. Nelson
Keyword(s):  
Treatment Strategy ◽  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Single Stage ◽  
Embolic Agent ◽  
Venous Aneurysm ◽  
Efficacy And Safety ◽  
Safety And Efficacy ◽  
Average Percentage ◽  
Brain Arteriovenous Malformations

Object Nidal embolization of brain arteriovenous malformations (bAVMs) has become an increasingly important component of bAVM treatment. However, controversy exists as to the relative efficacy and safety of single-stage versus multistage approaches to bAVM embolization, with recent literature favoring multistage strategies. The authors present a series of consecutive bAVMs embolized at their institution, demonstrating the safety and efficacy of a predominantly single-stage embolization strategy. The safety and efficacy of embolization are reported in the context of predetermined treatment strategies to provide more generalizable insight into treatment outcome. Methods One hundred thirty consecutive patients with 131 bAVMs underwent endovascular embolization at a single center. Diagnostic angiography with superselective microcatheterizations was performed in all patients. Postembolization angiograms were reviewed by 3 neuroradiologists for degree of occlusion and angiographic evidence of procedural complications. Patients were divided into cohorts based on the prospectively determined treatment strategy, which included the following: global devascularization of the bAVM (Devasc); targeting of a focal angioarchitectural weakness (Target), typically as an adjunct to surgery or Gamma Knife treatment; and primary occlusion of the bAVM by embolization alone (Occlude). Safety and efficacy were evaluated in the context of these treatment groups. Results The 131 bAVMs were treated over an average of 1.28 embolization sessions per bAVM; 105 bAVMs (80%) were treated in a single stage. The average percentage devascularization in the Devasc arm was 85.3%, which was statistically significantly greater than the 72% aggregate devascularization reported in 8 modern N-butyl cyanoacrylate and Onyx papers based on 1-sample Wilcoxon rank-sum testing (p < 0.001). Focal angioarchitectural weaknesses were successfully embolized for all 24 bAVMs in the Target group, directly with the embolic agent in 23 bAVMs and indirectly in 1 bAVM with a venous aneurysm/pseudoaneurysm by reducing arterial inflow and inducing venous thrombosis. Lesions in all patients in the Occlude arm were 100% occluded with embolization alone. Overall, the bAVMs in the Occlude arm were significantly smaller and required embolization of fewer pedicles than those in the Devasc group. One patient (0.8%) experienced significant morbidity following embolization, and 1 patient in the cohort died (0.8%). Conclusions This research communicates the authors' experience in developing a largely single-stage strategy for embolization of bAVMs. The results suggest that an aggressive, single-stage embolization may be implemented with a margin of safety and effectiveness similar to the multistage approaches more commonly reported in the literature. This work additionally introduces the importance of prospective assignment to a treatment strategy in assessing procedural outcome in bAVM embolization, thereby improving generalizability of the results and allowing for more rigorous interpretation of efficacy and safety.

scholarly journals Multimodal Treatment of Pediatric Ruptured Brain Arteriovenous Malformations: A Single-Center Study

Children ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 215
Author(s):  
Lukasz Antkowiak ◽  
Monika Putz ◽  
Marta Rogalska ◽  
Marek Mandera
Keyword(s):  
Medical Records ◽  
Arteriovenous Malformations ◽  
Pediatric Patients ◽  
Interventional Treatment ◽  
Digital Subtraction ◽  
Brain Arteriovenous Malformations ◽  
Single Center Study ◽  
Complete Obliteration ◽  
Multimodality Approach ◽  
Related Mortality

Bleeding from ruptured brain arteriovenous malformations (bAVMs) represents the most prevalent cause of pediatric intracranial hemorrhage, being also the most common initial bAVM manifestation. A therapeutic approach in these patients should aim at preventing rebleeding and associated significant morbidity and mortality. The purpose of this study was to determine the clinical outcomes of pediatric patients who initially presented at our institution with ruptured bAVMs and to review our experience with a multimodality approach in the management of pediatric ruptured bAVMs. We retrospectively reviewed pediatric patients’ medical records with ruptured bAVMs who underwent interventional treatment (microsurgery, embolization, or radiosurgery; solely or in combination) at our institution between 2011 and 2020. We identified 22 patients. There was no intraoperative and postoperative intervention-related mortality. Neither procedure-related complications nor rebleeding were observed after interventional treatment. Modified Rankin Scale (mRS) assessment at discharge revealed 19 patients (86.4%) with favorable outcomes (mRS 0–2) and 3 patients (13.6%) classified as disabled (mRS 3). Microsurgery ensured the complete obliteration in all patients whose postoperative digital subtraction angiography (DSA) was available. Management of high-grade bAVMs with radiosurgery or embolization can provide satisfactory outcomes without a high disability risk.

Sign in / Sign up

Export Citation Format

Share Document