Transvenous Embolization of Arteriovenous Malformation

Wednesday, 1 August 2012: 9:10 AM

Dinah Hernandez, MSN
Interventional Radiology, Kaiser Permanente, Los Angeles, CA

Learning Objective 1: The learner will be able to discover new technology/ treatment for AVMs.

Learning Objective 2: The learner will be able to gain knowledge on AVMs which at this time has not been given attention.

Purpose: Arteriovenous Malformations are defects of the circulating system that aregenerally believed to arise during embryonic or fetal development or soon after birth. They are comprised of snarled tangles of arteries and veins ( National Institute of Neurological Disorders and Stroke 2011). In this small case series, we report curative Transvenous Embolization of Craniofacial AVMs under transient arrest of arterial inflow. And because of the turtuosity of the distal feeding arteries and collaterals make it difficult to obliterate the nidus with transarterial embolization hence done transvenous.


Six patients with Craniofacial AVMs ( three in the scalp, one in the face and one in the forehead and one on the right facial parotid ) ages: 5-59 years were subjected for Transvenous Embolization with Onyx.


In all six cases, the dominant feeding arteries were first embolized with Onyx to reduce arterial inflow. The major draining veins were then accessed transfemorally or via direct puncture. Detachable coils were placed in the venous pouches to further obstruct the outflow from the AVM nidus. After arterial inflow was completely stopped with the placement of a tourniqute around the head or inflation of balloon catheter in the external carotid artery, Onyx was injected into the venous pouch to retrogradely fill AVM nidus.


Follow-up angiogram were performed one year later. The first two patients underwent surgical removal of Onyx cast which was scheduled prior to embolization. The other two patients were given options of surgery or  observation and both declined surgery. The latter two patients await for a one year follow-up. Angiographic cure was achieved in all four patients and no recurrence was found at one yeay follow-up angiogram.


Head and neck AVM can be cured with Transvenous Embolization using Onyx.