Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer - feasibility, technical outcomes, and clinical outcomes.
BACKGROUND
The technical and clinical outcomes of catheter-directed embolization for peripheral arteriovenous malformations (AVM) using Onyx® (ethylene-vinyl alcohol copolymer) are not well documented. The purpose of this study was to retrospectively assess the safety, technical outcomes and clinical outcomes of catheter-directed Onyx® embolisation for the treatment of symptomatic peripheral AVMs.


METHODS
Demographics, (pre-)interventional clinical and radiological data were assessed. Follow-up was based on hospital medical records and telephone calls to the patients' general practitioners. Radiological success was defined as complete angiographic eradication of the peripheral AVM nidus. Clinical success was defined as major clinical improvement or complete disappearance of the initial symptoms.


RESULTS
25 procedures were performed in 22 patients. The principal indications for treatment were pain (n = 10), limb swelling (n = 6), recurrent bleeding (n = 2), tinnitus (n = 3), and exertional dyspnoea (n = 1). Complete radiological success was obtained in eight patients (36 %); near-complete eradication of the nidus was achieved in the remaining 14 patients. Adjunctive embolic agents were used in nine patients (41 %). Clinical success was observed in 18 patients (82%). Major complications were reported in two patients (9 %). During follow-up, seven patients (32 %) presented with symptom recurrence, which required additional therapy in three patients.


CONCLUSIONS
Catheter-directed embolisation of peripheral AVMs with Onyx® resulted in major clinical improvement or complete disappearance of symptoms in the vast majority of patients, although complete angiographic exclusion of the AVMs occurred in only a minority of patients.
1 University Hospitals Leuven, Leuven, Belgium.
Tom
T
De Beule
1 University Hospitals Leuven, Leuven, Belgium.
Jan
J
Vranckx
1 University Hospitals Leuven, Leuven, Belgium.
Peter
P
Verhamme
1 University Hospitals Leuven, Leuven, Belgium.
Veerle
V
Labarque
1 University Hospitals Leuven, Leuven, Belgium.
Marie-Anne
MA
Morren
1 University Hospitals Leuven, Leuven, Belgium.
Inge
I
Fourneau
1 University Hospitals Leuven, Leuven, Belgium.
Geert
G
Maleux
D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage* / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls / Q000008:administration & dosage* / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide
Angiography; arteriovenous fistula; catheterization; digital subtraction angiography; embolization; microcatheter; therapeutic