CardioVascular and Interventional Radiology

, Volume 38, Issue 3, pp 623–631 | Cite as

The Retrograde Transvenous Push-Through Method: A Novel Treatment of Peripheral Arteriovenous Malformations with Dominant Venous Outflow

  • Walter A. WohlgemuthEmail author
  • René Müller-Wille
  • Veronika I. Teusch
  • Oliver Dudeck
  • Anne M. Cahill
  • Ahmad I. Alomari
  • Wibke UllerEmail author
Clinical Investigation



To evaluate the efficacy and safety of a novel retrograde transvenous embolization technique of peripheral arteriovenous malformations (AVMs) using Onyx.

Materials and Methods

We conducted a retrospective analysis of all patients who underwent transvenous retrograde Onyx embolization of peripheral AVMs with dominant venous outflow over a 29-month period. The embolization is aimed at retrograde filling of the nidus after building a solid plug in the dominant venous outflow (push-through). Classification, clinical signs, technical aspects, clinical and technical success rates, and complications were recorded. Short-term outcome was assessed.


11 Symptomatic patients (8 female; mean age 31.4 years) were treated at our Vascular Anomalies Center with this method between January 2012 and May 2014. The AVMs were located on the upper extremity (n = 3), pelvis (n = 2), buttock (n = 2), and lower extremity (n = 4). Retrograde embolization was successfully carried out after preparatory transarterial-flow reduction in eight cases (73 %) and venous-flow reduction with Amplatzer Vascular Plugs in four cases (36 %). Complete devascularization (n = 10; 91 %) or 95 % devascularization (n = 1; 9 %) led to complete resolution (n = 8; 73 %) or improvement of clinical symptoms (n = 3; 27 %). One minor complication occurred (pain and swelling). During a mean follow-up time of 8 months, one clinically asymptomatic recurrence of AVM was detected.


Initial results suggest that retrograde transvenous Onyx embolization of peripheral AVMs with dominant venous outflow is a safe and effective novel technique with a low complication rate.


Venous intervention Embolization/embolization/embolotherapy Vascular malformations Arteriovenous 


Conflicts of interest

Walter A. Wohlgemuth and René Müller-Wille have received a speaker honorarium from Covidien; Veronika I. Teusch, Oliver Dudeck, Anne M. Cahill, Ahmad I. Alomari and Wibke Uller declare that they have no conflicts of interest.

Informed Consent

For this type of study (retrospective study) formal consent is not required.


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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2015

Authors and Affiliations

  • Walter A. Wohlgemuth
    • 1
    Email author
  • René Müller-Wille
    • 1
  • Veronika I. Teusch
    • 1
  • Oliver Dudeck
    • 2
  • Anne M. Cahill
    • 3
  • Ahmad I. Alomari
    • 4
  • Wibke Uller
    • 1
    • 4
    Email author
  1. 1.Department of RadiologyUniversity Medical Center RegensburgRegensburgGermany
  2. 2.Department of Radiology and Nuclear MedicineUniversity of MagdeburgMagdeburgGermany
  3. 3.Division of Interventional Radiology, Department of Radiology, Children’s Hospital of PhiladelphiaPerelman School of Medicine of the University of PennsylvaniaPhiladelphiaUSA
  4. 4.Division of Vascular and Interventional RadiologyBoston Children’s Hospital and Harvard Medical SchoolBostonUSA

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