Advertisement

Arteriovenous malformation management

  • Wayne F. Yakes
  • Plinio Rossi
  • Henk Odink
How I Do It

Abstract

Arteriovenous malformations (AVM) are rare vascular lesions that can present with a myriad of clinical presentations. In our institutions, initial workup consists of a clinical exam, color Doppler imaging, and magnetic resonance imaging. After the initial nonivasive workup, arteriography, at times closed system venography, and ethanol endovascular repair of the AVM is performed under general anesthesia. Depending on the size of the lesion, additional Swan-Ganz line and arterial line monitoring are performed. Patients are usuallay observed overnight and uneventfully discharged the following day if no complication occurs. Patients are followed at periodic intervals despite cure of their lesion. Long-term follow-up is essential in AVM management.

Key words

Arteriovenous malformation Embolization Arterial therapeutic blockade Ethyl alcohol Endovascular management 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Yakes WF, Stavros AT, Parker SH, Luethke JM, Rak KM, Dreisbach JN, Slater DD, Burke BJ, Chantelois AE (1990) Color Doppler imaging of peripheral high-flow vascular malformations before and after ethanol embolotherapy. RSNA presentation. Radiology 177 (p):156Google Scholar
  2. 2.
    Rak KM, Yakes WF, Ray RL, Dresibach JM, Parker SH, Luethke JM, Stavros AT, Slater DD, Burke BJ (1992) MR imaging of symptomatic peripheral vascular malformations. AJR 159:107–112PubMedGoogle Scholar
  3. 3.
    Yakes WF, Haas DK, Parker SH, Gibson MD, Hopper KD, Mulligan JS, Pevsner PH, Johns JC Jr, Carter TE (1989) Symptomatic vascular malformations: Ethanol embolotherapy. Radiology 170:1059–1066PubMedGoogle Scholar
  4. 4.
    Szilagyi DE, Smith RF, Elliott JP, Hagenman JH (1976) Congenital arteriovenous anomalies of the limbs. Arch Surg 111:423–429PubMedGoogle Scholar
  5. 5.
    Decker DG, Fish CR, Juergens JL (1968) Arteriovenous fistulas of the female pelvis: A diagnostic problem. Obstet Gynecol 31:799–805Google Scholar
  6. 6.
    Flye MW, Jordan BP, Schwartz MZ (1983) Management of congenital arteriovenous malformation. Surgery 94:740–747PubMedGoogle Scholar
  7. 7.
    Tanner NSB, Pickford MA (1993) Preliminary report: Intratumoral ligation as a salvage procedure for the management of life-threatening arteriovenous malformations. Br J Plast Surg 46:694–702PubMedCrossRefGoogle Scholar
  8. 8.
    Habal MB, Murray JE (1972) The natural history of a benign locally invasive haemangioma of the orbital region. Plast Reconstr Surg 49:209–214PubMedCrossRefGoogle Scholar
  9. 9.
    Nakno H, Igawa M (1986) Complication after embolization of internal iliac artery by gelatin sponge powder. Hiroshima J Med Sci 35:21–25Google Scholar
  10. 10.
    Sware TA, Carrosco CH, Wallace S, Richli W (1986) Radiopaque suspension of polyvinyl alchohol foam for embolization. AJR 146:591–592Google Scholar
  11. 11.
    Brothers MF, Kaufmann JCE, Fox AJ, Deveikis JP (1988) N-butyl-2-cyanoacrylate substitute for IBCA in interventional radiology: Histopathologic and polymerization times studies. AJR 10:777–786Google Scholar
  12. 12.
    Widlus DM, Murray RR, White RI Jr, Schreiber ER, Satre RW, Mitchell SE, Kaufman SL, Williams GM, Weiland AJ (1988) Congenital arteriovenous malformations: Tailored embolotherapy. Radiology 169:511–516PubMedGoogle Scholar
  13. 13.
    Riche MC, Hadjean E, Tran-Ba-Huy P, Merland JJ (1983) The treatment of capillary-venous malformations using a new fibrosing agent. Plast Reconstr Surg 71:607–612PubMedCrossRefGoogle Scholar
  14. 14.
    Hasimoto Y, Matsuhiro K, Nagaki M, Tanioka H (1988) Therapeutic embolization for vascular lesions of the head and neck. Int J Oral Maxillofac Surg 18:47–49CrossRefGoogle Scholar
  15. 15.
    Persky MS, Berenstein A, Cohen NL (1984) Combined treatment of head and neck vascular masses with preoperative embolization. Layrngoscope 94:20–27Google Scholar
  16. 16.
    Strachan J, Hemingway AP, Mansfield AO, Allison DJ (1986) Embolization of an arteriovenous malformation following surgical reconstruction of a previously ligated, lingual artery. J Intervent Radiol 1:79–82Google Scholar
  17. 17.
    Anavi Y, Har-El G, Mintz S (1988) The treatment of facial hemangioma by percutaneous injections of sodium tetradecyl sulfate. J Laryngol Otol 102:87–91PubMedGoogle Scholar
  18. 18.
    Rao VRK, Mandalan KR, Gupta AK, Kumar S, Joseph S (1989) Dissolution of isobutyl 2-cyanoacrylate on long-term follow-up. AJNR 10:135–141PubMedGoogle Scholar
  19. 19.
    Yakes WE, Pevsner PH, Reed MD, Donohue HJ, Ghaed M (1986) Serial embolizations of an extremity arteriovenous malformation with alcohol via direct percutaneous puncture. AJR 146:1038–1040PubMedGoogle Scholar
  20. 20.
    Takebayaski S, Hosaka M, Ishizuka E, Hirokawa M, Matsui K (1988) Arteriovenous malformations of the kidneys: Ablation with alcohol. AJR 150:587–590Google Scholar
  21. 21.
    Vinson AM, Rohrer DB, Willcox CW, Sigfred SV, Wheeler JR, Jacobs JS, Ruffin W Jr (1988) Absolute ethanol embolization for peripheral arteriovenous malformation: Report of two cures. South Med J 1:1052–1055CrossRefGoogle Scholar
  22. 22.
    Yakes WF, Haas DK, Parker SH, Gibson MD, Hopper KD, Mulligan JS, Pevsner PH, Johns JR Jr, Carter TE (1989) Alcohol embolotherapy of vascular malformations. Semin Intervent Radiol 6:146–161Google Scholar
  23. 23.
    Yakes WF, Luethke JM, Parker SH, Stavros AT, Rak KM, Hopper KD, Dreisbach JN, Griffin DJ, Seibert CE, Carter TE, Guilliland JD (1990) Ethanol embolization of vascular malformations. Radiographics 10:787–796PubMedGoogle Scholar
  24. 24.
    Yakes WF, Luethke JM, Merland JJ, Rak KM, Slater DD, Hollis HW, Parker SH, Hodes JF, Casasco A, Hopper KD, Stavros AT, Carter TE (1990) Ethanol embolization of arteriovenous fistulas: A primary mode of therapy. J Vasc Intervent Radiol 1:89–96Google Scholar
  25. 25.
    Mourao GS, Hodes JE, Gobin YP, Casasco A, Aymard A, Merland JJ (1991) Curative treatment of scalp arteriovenous fistulas by direct punture and embolization with absolute alcohol. J Neurosurg 75:634–637PubMedCrossRefGoogle Scholar
  26. 26.
    Yakes WF (1994) Extremity venous malformations: Diagnosis and management. Semin Intervent Radiol 11:332–339CrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 1996

Authors and Affiliations

  • Wayne F. Yakes
    • 1
  • Plinio Rossi
    • 2
  • Henk Odink
    • 3
  1. 1.Interventional Radiology and Interventional Neuroradiology, Radiology Imaging Associates, P.C.Colorado Neurological Institute, Swedish Medical CenterEnglewoodUSA
  2. 2.Department of RadiologyUniversita Degli Studi Di RomaRomeItaly
  3. 3.Department of RadiologyDe Wever HospitalHeerlenThe Netherlands

Personalised recommendations