title: Prioritized Venous Coiling Facilitating Endovascular Treatment of Brain Arteriovenous Malformations with a Fistulous Component.
abstract: BACKGROUND
  Brain arteriovenous malformation (AVM) with a fistulous component presents a treatment challenge. The presence of the fistulous component may be related to either a complication from endovascular treatment, perioperative hemorrhagic events during surgical resection, or incomplete obliteration after radiosurgery.
  
  
  METHODS
  From December 2010 to May 2014, 7 consecutive patients (3 men, 4 women, average age, 28.7 years; age range, 11 months to 67 years) with AVMs with a high-flow fistulous component were treated at our institute with venous coiling before transarterial liquid embolization. One AVM was grade I based on the Spetzler-Martin grading system, 1 was grade II, 3 were grade III, and 2 were grade IV. The nidus size ranged from 1.7 to 6.0 cm. Four patients had pure fistulous-type lesions, and 3 had lesions of the mixed fistulous-plexiform type. All AVMs shared a common feature of a high-flow fistulous component with a large venous pouch emerging from the nidus. After endovascular embolization of the AVMs, 3 patients had complete occlusion, 3 patients had near-complete occlusion, and 1 patient had significant reduction in volume. There was no immediate complication after embolization, but 1 patient experienced delayed hemorrhage 3 days after the procedure.
  
  
  CONCLUSIONS
  Prioritized transarterial venous coiling is feasible for the embolization of AVMs with a high-flow fistulous component and the procedure had an acceptable complication rate.
authors: Department of Neurosurgery, Cheng-Hsin General Hospital, Taipei, Taiwan.
authors: Yu-Hone
authors: YH
authors: Hsu
authors: Section of Neuroradiology, Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
authors: Chung-Wei
authors: CW
authors: Lee
authors: Section of Neuroradiology, Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: honman8591@gmail.com.
authors: Hon-Man
authors: HM
authors: Liu
authors: Section of Neuroradiology, Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
authors: Yao-Hung
authors: YH
authors: Wang
authors: Section of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors: Meng-Fai
authors: MF
authors: Kuo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis*; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Arteriovenous malformation; Brain; Endovascular treatment; Fistulous component; Prioritized venous coiling