title: Double Coaxial Microcatheter Technique for Glue Embolization of Renal Arteriovenous Malformations.
abstract: OBJECTIVE
  To demonstrate the technical benefit of the double coaxial microcatheter technique for embolization of renal arteriovenous malformations (AVMs) with n-butyl cyanoacrylate and iodized oil (glue).
  
  
  METHODS
  Six consecutive patients (1 man and 5 women; mean age 61 years; range 44-77 years) with renal AVMs were included. Five patients had hematuria, and one had a risk of heart failure due to a large intrarenal arteriovenous shunt. All patients underwent transarterial embolization using glue and the double coaxial microcatheter technique with outer 2.6F and inner 1.9F microcatheters. After glue injection, the inner microcatheter was retracted, while the outer microcatheter was retained. We assessed the complications and clinical outcomes of this technique.
  
  
  RESULTS
  Technical success was achieved in all patients. In 9 sessions, 34 feeding arteries were embolized with glue using the double coaxial microcatheter technique, 1 was embolized with glue using a single microcatheter, and 2 were embolized with coils. The double coaxial microcatheter technique was useful for selecting small tortuous feeding arteries, preventing glue reflux to the proximal arteries, and approaching multiple feeding arteries without complete retraction of the microcatheters. As a minor complication, glue migrated into the venous system in four patients without any sequelae. In all patients, favorable clinical outcomes, including hematuria cessation in five patients and improvement of the large intrarenal arteriovenous shunt in one patient, were obtained without deterioration of renal function.
  
  
  CONCLUSIONS
  Glue embolization with the double coaxial microcatheter technique was useful for treating renal AVMs with multiple tortuous feeding arteries.
authors.affiliation: Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan. jauchikawa@gmail.com.|Department of Radiology, Hitachi General Hospital, 2-1-1 Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan. jauchikawa@gmail.com.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Uchikawa
authors.affiliation: Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. moriken@md.tsukuba.ac.jp.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Radiology, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan. m_41gai@yahoo.co.jp.
authors.forename: Masanari
authors.initials: M
authors.lastname: Shiigai
authors.affiliation: Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan. soratobukangaruu@gmail.com.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Konishi
authors.affiliation: Department of Radiology, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki, 309-1793, Japan. hoshiai@sb4.so-net.ne.jp.
authors.forename: Sodai
authors.initials: S
authors.lastname: Hoshiai
authors.affiliation: Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan. suzutokei@gmail.com.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Ishigro
authors.affiliation: Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan. med-tak@hotmail.com.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hiyama
authors.affiliation: Department of Neurosurgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan. nakaiya@tmch.or.jp.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Nakai
authors.affiliation: Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. mminami@md.tsukuba.ac.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Minami
mesh_terms: D000269:Adhesives / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007459:Iodized Oil; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome
chemical_list: D000269:Adhesives; D003287:Contrast Media; D007459:Iodized Oil; D004659:Enbucrilate
keywords: Coaxial microcatheters; Renal arteriovenous malformation; Transarterial embolization; n-Butyl cyanoacrylate