title: The retrograde transvenous push-through method: a novel treatment of peripheral arteriovenous malformations with dominant venous outflow.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of a novel retrograde transvenous embolization technique of peripheral arteriovenous malformations (AVMs) using Onyx.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  11 Symptomatic patients (8 female; mean age 31.4 years) were treated at our Vascular Anomalies Center with 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.
  
  
  CONCLUSIONS
  Initial 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.
authors.affiliation: Department of Radiology, University Medical Center Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany, walter.wohlgemuth@ukr.de.
authors.forename: Walter A
authors.initials: WA
authors.lastname: Wohlgemuth
authors.forename: René
authors.initials: R
authors.lastname: Müller-Wille
authors.forename: Veronika I
authors.initials: VI
authors.lastname: Teusch
authors.forename: Oliver
authors.initials: O
authors.lastname: Dudeck
authors.forename: Anne M
authors.initials: AM
authors.lastname: Cahill
authors.forename: Ahmad I
authors.initials: AI
authors.lastname: Alomari
authors.forename: Wibke
authors.initials: W
authors.lastname: Uller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000628:therapy*; D002648:Child; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012997:Solvents / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012997:Solvents; D004121:Dimethyl Sulfoxide