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Transvenous embolization of arteriovenous malformations
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Transvenous embolization of arteriovenous malformations
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Journal Article
Transvenous embolization of arteriovenous malformations
2019
Overview
•Embolization of AVMs is most commonly performed transarterially.•Transvenous embolization proves useful in treating transarterially-inaccessible AVMs.•Transvenous embolization achieves excellent obliteration rates as monotherapy.•Complications result from venous occlusion, arterial embolisate reflux, and catheter navigation.•Innovation in endovascular strategies optimizes outcomes and minimizes neurologic morbidity.
Embolization of arteriovenous malformations is characteristically used as part of a multimodal treatment approach, pre-operatively to facilitate microsurgical resection or as a preradiosurgical adjunct. The concept of AVM cure via embolization alone has gained popularity in recent years. Embolization of AVMs has been most commonly performed transarterially, with the transvenous route traditionally eschewed given concern over precipitating premature venous occlusion and consequent hemorrhage. However, the transvenous approach in treating AVMs offers several distinct advantages compared to the transarterial route and can be used in instances when the latter is not feasible, with several series having proven its efficacy and safety. Conceptually, AVM embolization performed via the transvenous route achieves complete obliteration by directly and facilely targeting the nidus. Nidal embolisate penetration is facilitated by control of arterial inflow via systemic or local hypotension. Innovation in endovascular strategies has led to significantly improved obliteration rates. The experience with transvenous AVM embolization is reviewed and discussed.
Publisher
Elsevier B.V,Elsevier Limited
