Selection of Patients for Treatment of Brain Arteriovenous Malformations by the Transvenous Approach: Relationship with Venous Anatomy and Risk of Hemorrhagic Complications

Objective. To estimate the detection rate of brain arteriovenous malformations (AVMs) in the Chuvash Republic and their characteristics.Material and methods. The results of CT angiographies performed at the Unit of Radiation Diagnosis in 2014–2017 were retrospectively analyzed.Results. Over 4 years, brain AVMs were first detected in 29 patients (5–9 cases per year); of them 59% were men and 41% were women. The peak detectability occurred at the age of 31–40 years. AVMs were more frequently localized in the frontal and temporal regions. The high risk of surgery for AVMs according to the grading scheme by R. Spetzler and N. Martin (1986) occurred in 10% of cases. Besides AVMs, cerebral vascular aneurysms were detected in 14% of patients.Conclusion. Small AVMs with a low risk of surgery are more common; however, there is a higher risk of hemorrhagic complications. The risk of cerebral hemorrhage is higher when AVMs are fed by the internal carotid arteries and drained into the deep veins. The likelihood of strokes in AVMs is 27% higher in patients with the open circle of Willis.

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

Neurosurgery ◽

10.1227/neu.0b013e318212bb34 ◽

2011 ◽

Vol 69 (1) ◽

pp. 184-193 ◽

Cited By ~ 37

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.

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Operative Selection of Patients with Arteriovenous Malformations

Advances in Surgery for Cerebral Stroke ◽

10.1007/978-4-431-68314-8_88 ◽

1988 ◽

pp. 481-486 ◽

Cited By ~ 2

Author(s):

Robert F. Spetzler ◽

Joseph M. Zabramski

Keyword(s):

Arteriovenous Malformations ◽

Selection Of Patients ◽

Selection Of

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

Neurosurgical FOCUS ◽

10.3171/2018.3.focus18113 ◽

2018 ◽

Vol 45 (1) ◽

pp. E13 ◽

Cited By ~ 12

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.

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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

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-018097 ◽

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.

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THE RESULTS OF AN AIMED INCOMPLETE MYOCARDIAL REVASCULARIZATION WITH LOW INVASIVE AND STANDARD TECHNICS OF CORONARY BYPASS

Russian Journal of Cardiology ◽

10.15829/1560-4071-2018-7-47-52 ◽

2018 ◽

pp. 47-52

Author(s):

R. S. Tarasov ◽

A. N. Kazantsev ◽

L. S. Barbarash ◽

M. G. Zinets ◽

A. I. Danilovich ◽

...

Keyword(s):

Myocardial Revascularization ◽

Early Period ◽

Coronary Bypass ◽

Medication Therapy ◽

Post Surgery ◽

Hemorrhagic Complications ◽

Duration Of Hospitalization ◽

Selection Of Patients ◽

Selection Of

Aim.Comparison of in-hospital results of two strategies on an aimed incomplete myocardial revascularization (AIMR) ONCAB and MIDCAB of left anterior descending artery (LAD) in multivessel coronary disease patients.Material and methods.To the study, 63 patients included with achieved AIMR (LAD shunting) in multivessel disease. All patients, depending on the strategy of revascularization, were selected to 2 groups: 1. ONCAB (47,6%, n=30) and 2. MIDCAB (52,4%, n=33).Results.In the early post-surgery period of follow-up, among the adverse cardiovascular events, in the general selection of patients, there was non-fatal Q-myocardial infarction in MIDCAB group, followed by a decline of the left ventricle ejection fraction from 65% to 38%. ONCAB group was characterized by higher volume intra-operational blood loss, rate of wound and hemorrhagic complications, that in one case led to remediastinotomy, and in every tenth patient — blood transfusion during the early period. In our study, the chosen surgical strategy was the only alternative to medication therapy.Conclusion.In the study, at in-hospital stage of management there were comparable outcomes of AIMR with either ONCAB and MIDCAB. Nevertheless, coronary bypass with MIDCAB technology demonstrated a range of benefits related to decreased risk of hemorrhagic complications, wound infection and lower duration of hospitalization.

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