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Embolization techniques for high-flow arteriovenous malformations with a dominant outflow vein.
J Vasc Surg Venous Lymphat Disord. 2015 Apr; 3(2):178-83.JV

Abstract

OBJECTIVE

The aim of this study was to assess the management and outcomes of arteriovenous malformations (AVMs) with a dominant outflow vein (DOV) treated with retrograde venous embolization.

METHODS

A retrospective review was performed from November 2010 to May 2014 on all patients with a high-flow AVM and associated DOV who underwent transvenous embolization of the DOV. Indications, techniques, complications, and outcomes were reviewed.

RESULTS

Fourteen patients (five male; 36%) underwent transvenous embolization of high-flow AVMs with a DOV. Median age was 41.6 years (15.7-65.8 years). The AVM was located on an extremity in eight patients (57%) and in the pelvis in six patients (43%). The indication for the procedure was pain in 11 patients (79%), swelling in 3 patients (21%), a nonhealing wound in 1 patient (7%), and impotence in 1 patient (7%). The median number of prior procedures to treat the AVM was 2.5 (0-13). Transvenous embolization with coils was performed in 13 patients (93%). The Amplatzer vascular plug and Amplatzer septal occluder (St. Jude Medical, St. Paul, Minn) were used in four patients (29%). Concurrent percutaneous puncture embolization of the AVM nidus was used in seven patients (50%) and transcatheter arterial embolization in eight patients (57%). Technical angiographic success was seen in all patients. Five patients (36%) experienced a complete response to treatment, whereas eight (57%) experienced a partial response. Seven patients (50%) required further procedures for residual symptoms.

CONCLUSIONS

AVMs with a DOV can be successfully treated by a transvenous approach. Percutaneous puncture embolization of the nidus or draining vein and transcatheter arterial embolization may assist in reducing flow.

Authors+Show Affiliations

Lenox Hill Heart & Vascular Institute of New York, Lenox Hill Hospital, North Shore-LIJ Health System, New York, NY. Electronic address: allan.m.conway@doctors.org.uk.Lenox Hill Heart & Vascular Institute of New York, Lenox Hill Hospital, North Shore-LIJ Health System, New York, NY.Lenox Hill Heart & Vascular Institute of New York, Lenox Hill Hospital, North Shore-LIJ Health System, New York, NY.Lenox Hill Heart & Vascular Institute of New York, Lenox Hill Hospital, North Shore-LIJ Health System, New York, NY.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26993837

Citation

Conway, Allan M., et al. "Embolization Techniques for High-flow Arteriovenous Malformations With a Dominant Outflow Vein." Journal of Vascular Surgery. Venous and Lymphatic Disorders, vol. 3, no. 2, 2015, pp. 178-83.
Conway AM, Qato K, Drury J, et al. Embolization techniques for high-flow arteriovenous malformations with a dominant outflow vein. J Vasc Surg Venous Lymphat Disord. 2015;3(2):178-83.
Conway, A. M., Qato, K., Drury, J., & Rosen, R. J. (2015). Embolization techniques for high-flow arteriovenous malformations with a dominant outflow vein. Journal of Vascular Surgery. Venous and Lymphatic Disorders, 3(2), 178-83. https://doi.org/10.1016/j.jvsv.2014.12.003
Conway AM, et al. Embolization Techniques for High-flow Arteriovenous Malformations With a Dominant Outflow Vein. J Vasc Surg Venous Lymphat Disord. 2015;3(2):178-83. PubMed PMID: 26993837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Embolization techniques for high-flow arteriovenous malformations with a dominant outflow vein. AU - Conway,Allan M, AU - Qato,Khalil, AU - Drury,Jennifer, AU - Rosen,Robert J, Y1 - 2015/02/11/ PY - 2014/10/08/received PY - 2014/12/22/accepted PY - 2016/3/20/entrez PY - 2016/3/20/pubmed PY - 2017/9/14/medline SP - 178 EP - 83 JF - Journal of vascular surgery. Venous and lymphatic disorders JO - J Vasc Surg Venous Lymphat Disord VL - 3 IS - 2 N2 - OBJECTIVE: The aim of this study was to assess the management and outcomes of arteriovenous malformations (AVMs) with a dominant outflow vein (DOV) treated with retrograde venous embolization. METHODS: A retrospective review was performed from November 2010 to May 2014 on all patients with a high-flow AVM and associated DOV who underwent transvenous embolization of the DOV. Indications, techniques, complications, and outcomes were reviewed. RESULTS: Fourteen patients (five male; 36%) underwent transvenous embolization of high-flow AVMs with a DOV. Median age was 41.6 years (15.7-65.8 years). The AVM was located on an extremity in eight patients (57%) and in the pelvis in six patients (43%). The indication for the procedure was pain in 11 patients (79%), swelling in 3 patients (21%), a nonhealing wound in 1 patient (7%), and impotence in 1 patient (7%). The median number of prior procedures to treat the AVM was 2.5 (0-13). Transvenous embolization with coils was performed in 13 patients (93%). The Amplatzer vascular plug and Amplatzer septal occluder (St. Jude Medical, St. Paul, Minn) were used in four patients (29%). Concurrent percutaneous puncture embolization of the AVM nidus was used in seven patients (50%) and transcatheter arterial embolization in eight patients (57%). Technical angiographic success was seen in all patients. Five patients (36%) experienced a complete response to treatment, whereas eight (57%) experienced a partial response. Seven patients (50%) required further procedures for residual symptoms. CONCLUSIONS: AVMs with a DOV can be successfully treated by a transvenous approach. Percutaneous puncture embolization of the nidus or draining vein and transcatheter arterial embolization may assist in reducing flow. SN - 2213-3348 UR - https://www.unboundmedicine.com/medline/citation/26993837/Embolization_techniques_for_high_flow_arteriovenous_malformations_with_a_dominant_outflow_vein_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-333X(15)00005-0 DB - PRIME DP - Unbound Medicine ER -