title: Embolization techniques for high-flow arteriovenous malformations with a dominant outflow vein.
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.affiliation: 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.
authors.forename: Allan M
authors.initials: AM
authors.lastname: Conway
authors.affiliation: Lenox Hill Heart & Vascular Institute of New York, Lenox Hill Hospital, North Shore-LIJ Health System, New York, NY.
authors.forename: Khalil
authors.initials: K
authors.lastname: Qato
authors.affiliation: Lenox Hill Heart & Vascular Institute of New York, Lenox Hill Hospital, North Shore-LIJ Health System, New York, NY.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Drury
authors.affiliation: Lenox Hill Heart & Vascular Institute of New York, Lenox Hill Hospital, North Shore-LIJ Health System, New York, NY.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014680:Veins / Q000473:pathology; D055815:Young Adult