The Retrograde Transvenous Push-Through Method: A Novel Treatment of Peripheral Arteriovenous Malformations with Dominant Venous Outflow
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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.
KeywordsVenous 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.
For this type of study (retrospective study) formal consent is not required.
- 1.Lee BB, Baumgartner I, Berlien HP, Bianchini G, Burrows P, Do YS et al, Consensus Document of the International Union of Angiology (IUA)-2013 (2013) Current concept on the management of arterio-venous management. Int Angiol 32(1):9–36Google Scholar
- 19.Vogelzang R (2012) Severe pulmonary embolic complications of ethanol embolotherapy of vascular anomalies. In: 19th International workshop on vascular anomalies, 16–19 June 2012, Malmö, SwedenGoogle Scholar