Anthony Lamanna1,2, Julian Maingard3,4, Grace Florescu3, Hong Kuan Kok4,5, Dinesh Ranatunga6, Christen Barras7, Michael J Lee8, Duncan Mark Brooks6,9,4,10,11, Ashu Jhamb9,11, Ronil V Chandra3, Hamed Asadi6,9,3,4,10,11. 1. Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia. anton.lamanna92@gmail.com. 2. Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia. anton.lamanna92@gmail.com. 3. Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia. 4. School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia. 5. Interventional Radiology Service, Northern Health Radiology, Melbourne, Australia. 6. Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia. 7. South Australian Health and Medical Research Institute, Adelaide, Australia. 8. Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland. 9. Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia. 10. Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia. 11. Interventional Neuroradiology Service, Department of Radiology, St Vincent's Hospital, Melbourne, Australia.
Abstract
PURPOSE: Arteriovenous malformations (AVMs) are abnormal communications between arteries and veins without an intervening capillary system. The best endovascular treatment option for these is unclear and may involve multiple staged procedures using a variety of embolic materials. We report our initial experience using a modified version of a previously published neurointerventional technique to treat soft tissue AVMs with single-stage curative intent. MATERIALS AND METHODS: Soft tissue AVMs treated endovascularly using either sole arterial or combined arterial and venous balloon-assisted techniques with liquid embolic agents were retrospectively identified over a 3.5 year period (January 2017 to June 2020)) at two centres. Clinical, pre-operative radiological, procedural technical and post treatment details were recorded. RESULTS: Seven patients were treated for symptomatic soft tissue arteriovenous malformations. These AVMs were located in the peripheral limbs (five), tongue (one) and uterus (one). Curative treatment was achieved in 6/7 patients with one patient requiring a second treatment approximately 1 year later. A variety of liquid embolisation agents (LEAs) including sclerosants and polymers were used. Clinical success rate was 100% following treatment. One patient experienced expected temporary post-operative tongue swelling requiring tracheostomy occurred following embolisation of the lingual AVM. A minor complication in a second patient was due to an access site haematoma developed following treatment of the hand AVM requiring surgical intervention. No long-term sequelae or additional complications were observed. CONCLUSION: Endovascular arterial and venous balloon assisted LEA embolization of soft tissue AVMs with curative intent is feasible. This technique may provide an alternative treatment option for achieving durable occlusion for complex soft tissue AVMs.
PURPOSE:Arteriovenous malformations (AVMs) are abnormal communications between arteries and veins without an intervening capillary system. The best endovascular treatment option for these is unclear and may involve multiple staged procedures using a variety of embolic materials. We report our initial experience using a modified version of a previously published neurointerventional technique to treat soft tissue AVMs with single-stage curative intent. MATERIALS AND METHODS: Soft tissue AVMs treated endovascularly using either sole arterial or combined arterial and venous balloon-assisted techniques with liquid embolic agents were retrospectively identified over a 3.5 year period (January 2017 to June 2020)) at two centres. Clinical, pre-operative radiological, procedural technical and post treatment details were recorded. RESULTS: Seven patients were treated for symptomatic soft tissue arteriovenous malformations. These AVMs were located in the peripheral limbs (five), tongue (one) and uterus (one). Curative treatment was achieved in 6/7 patients with one patient requiring a second treatment approximately 1 year later. A variety of liquid embolisation agents (LEAs) including sclerosants and polymers were used. Clinical success rate was 100% following treatment. One patient experienced expected temporary post-operative tongue swelling requiring tracheostomy occurred following embolisation of the lingual AVM. A minor complication in a second patient was due to an access site haematoma developed following treatment of the hand AVM requiring surgical intervention. No long-term sequelae or additional complications were observed. CONCLUSION: Endovascular arterial and venous balloon assisted LEA embolization of soft tissue AVMs with curative intent is feasible. This technique may provide an alternative treatment option for achieving durable occlusion for complex soft tissue AVMs.
Authors: B B Lee; I Baumgartner; H P Berlien; G Bianchini; P Burrows; Y S Do; K Ivancev; L S Kool; J Laredo; D A Loose; J C Lopez-Gutierrez; R Mattassi; K Parsi; U Rimon; M Rosenblatt; C Shortell; R Simkin; F Stillo; L Villavicencio; W Yakes Journal: Int Angiol Date: 2013-02 Impact factor: 2.789
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