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Title: A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch

Abstract

Management of arteriovenous malformations (AVMs) is challenging, and there is no consensus regarding either the ideal approach or the treatment timing. Percutaneous embolization is the most frequent approach currently used and is considered the first-line technique for AVMs. There is an ongoing discussion about the best technical approach to embolize AVMs. AVMs associated with a dominant outflow vein (DOV) are rare. Embolization of both the DOV and the nidus is considered more effective. Herein, we report a novel technique of transvenous embolization of a DOV under negative pressure from an arterial balloon catheter in a case of a peripheral AVM. This technique allows the embolization of the DOV and the nidus retrogradely.

Authors:
; ; ;  [1];  [2];  [1]
  1. Kurume University School of Medicine, Department of Radiology (Japan)
  2. Kurume University School of Medicine, Department of Plastic & Reconstructive Surgery and Maxillofacial Surgery (Japan)
Publication Date:
OSTI Identifier:
22645225
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 40; Journal Issue: 5; Other Information: Copyright (c) 2017 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BALLOONS; BIOMEDICAL RADIOGRAPHY; MALFORMATIONS; VASCULAR DISEASES; VEINS

Citation Formats

Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp, Tanaka, Norimitsu, Koganemaru, Masamichi, Kugiyama, Tomoko, Kiyokawa, Kensuke, and Abe, Toshi. A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch. United States: N. p., 2017. Web. doi:10.1007/S00270-016-1548-2.
Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp, Tanaka, Norimitsu, Koganemaru, Masamichi, Kugiyama, Tomoko, Kiyokawa, Kensuke, & Abe, Toshi. A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch. United States. doi:10.1007/S00270-016-1548-2.
Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp, Tanaka, Norimitsu, Koganemaru, Masamichi, Kugiyama, Tomoko, Kiyokawa, Kensuke, and Abe, Toshi. Mon . "A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch". United States. doi:10.1007/S00270-016-1548-2.
@article{osti_22645225,
title = {A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch},
author = {Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp and Tanaka, Norimitsu and Koganemaru, Masamichi and Kugiyama, Tomoko and Kiyokawa, Kensuke and Abe, Toshi},
abstractNote = {Management of arteriovenous malformations (AVMs) is challenging, and there is no consensus regarding either the ideal approach or the treatment timing. Percutaneous embolization is the most frequent approach currently used and is considered the first-line technique for AVMs. There is an ongoing discussion about the best technical approach to embolize AVMs. AVMs associated with a dominant outflow vein (DOV) are rare. Embolization of both the DOV and the nidus is considered more effective. Herein, we report a novel technique of transvenous embolization of a DOV under negative pressure from an arterial balloon catheter in a case of a peripheral AVM. This technique allows the embolization of the DOV and the nidus retrogradely.},
doi = {10.1007/S00270-016-1548-2},
journal = {Cardiovascular and Interventional Radiology},
number = 5,
volume = 40,
place = {United States},
year = {Mon May 15 00:00:00 EDT 2017},
month = {Mon May 15 00:00:00 EDT 2017}
}
  • We successfully performed embolization therapy for a pelvic arteriovenous malformation by the retrograde transvenous approach using a liquid embolic material. This malformation was unique in that it had a single draining vein, which allowed this technique employing an occlusion balloon.
  • PurposeTo evaluate the efficacy and safety of a novel retrograde transvenous embolization technique of peripheral arteriovenous malformations (AVMs) using Onyx.Materials and MethodsWe conducted a retrospective analysis of all patients who underwent transvenous retrograde Onyx embolization of peripheral AVMs with dominant venous outflow over a 29-month period. The embolization is aimed at retrograde filling of the nidus after building a solid plug in the dominant venous outflow (push-through). Classification, clinical signs, technical aspects, clinical and technical success rates, and complications were recorded. Short-term outcome was assessed.Results11 Symptomatic patients (8 female; mean age 31.4 years) were treated at our Vascular Anomalies Center withmore » this method between January 2012 and May 2014. The AVMs were located on the upper extremity (n = 3), pelvis (n = 2), buttock (n = 2), and lower extremity (n = 4). Retrograde embolization was successfully carried out after preparatory transarterial-flow reduction in eight cases (73 %) and venous-flow reduction with Amplatzer Vascular Plugs in four cases (36 %). Complete devascularization (n = 10; 91 %) or 95 % devascularization (n = 1; 9 %) led to complete resolution (n = 8; 73 %) or improvement of clinical symptoms (n = 3; 27 %). One minor complication occurred (pain and swelling). During a mean follow-up time of 8 months, one clinically asymptomatic recurrence of AVM was detected.ConclusionInitial results suggest that retrograde transvenous Onyx embolization of peripheral AVMs with dominant venous outflow is a safe and effective novel technique with a low complication rate.« less
  • Purpose: To report the clinical efficiency and complications in patients treated with retrograde transvenous ethanol embolization of high-flow peripheral arteriovenous malformations (AVMs). Retrograde transvenous ethanol embolization of high-flow AVMs is a technique that can be used to treat AVMs with a dominant outflow vein whenever conventional interventional procedures have proved insufficient. Methods: This is a retrospective study of the clinical effectiveness and complications of retrograde embolization in five patients who had previously undergone multiple arterial embolization procedures without clinical success. Results: Clinical outcomes were good in all patients but were achieved at the cost of serious, although transient, complications inmore » three patients. Conclusion: Retrograde transvenous ethanol embolization is a highly effective therapy for high-flow AVMs. However, because of the high complication rate, it should be reserved as a last resort, to be used after conventional treatment options have failed.« less
  • We report a 70-year-old woman with hepatic encephalopathy due to an intrahepatic portosystemic venous shunt that was successfully occluded by percutaneous transcatheter embolization with n-butyl cyanoacrylate and microcoils.
  • A 60-year-old woman with massive hemorrhage from duodenal varices was transferred to our hospital for the purpose of transcatheter intervention. Although digital subtraction arterial portography could not depict the entire pathway of collateral circulation, the efferent route of the duodenal varices was clearly demonstrated on subsequent CT during arterial portography. Balloon-occluded retrograde transvenous obliteration (B-RTO) of the varices was performed via the efferent vein and achieved complete thrombosis of the varices.