Arteriovenous Malformations ; pathology ; therapy ; Brain Diseases ; pathology ; therapy ; Embolization, Therapeutic ; methods ; Humans ; Polyvinyls ; therapeutic use ; Treatment Outcome

Pancreatic arteriovenous malformations (AVM) are extremely rare diseases frequently complicated by gastrointestinal hemorrhage. While surgical resection of affected lesion is preferred for the treatment of pancreatic AVM, angiographic intervention can be used as an alternative treatment, especially in surgically high-risk patients. We experienced a patient with pancreatic AVM manifested by hemobilia and biliary sepsis. Superior mesenteric and common hepatic arteriography showed pancreaticoduodenal AVM composed of nidus supplied by numerous fine feeding arteries and of draining veins encircling the common bile duct (CBD). Hemobilia was controlled by transportal coil embolization of draining veins of AVM around the CBD. Herein, we report this case with the review of literatures.
Arteriovenous Malformations/pathology/*therapy ; Duodenoscopy ; *Embolization, Therapeutic ; Hemobilia/etiology/pathology/*therapy ; Humans ; Male ; Middle Aged ; Pancreas/*blood supply ; Pancreaticoduodenectomy ; Tomography, X-Ray Computed

BACKGROUNDEndovascular therapy plays an important role in the treatment of brain arteriovenous malformations (BAVMs). Ethylene vinyl alcohol copolymer (Onyx) is a novel liquid embolic material. This study aimed to summarize our experience of using Onyx for embolization of BAVMs with the focus on embolization technique.

METHODSFrom September 2003 to November 2007, 115 patients (43 women and 72 men, with a mean age of 29 years) with BAVMs were endovascularly treated with Onyx in our department. The following features of all AVMs were evaluated prior to treatment: type of nidus and shunt, draining veins, and feeding arteries. A total of 196 endovascular procedures were performed.

RESULTSThe course of endovascular treatment was completed in 88 patients. Additional sessions were planned in 27 patients. Of the 88 patients, total occlusion was obtained in 23 patients (26.1%), near-total (> 80% of the original volume) occlusion was obtained in 35 patients (39.8%) and partial occlusion (< 80% of the original volume) was obtained in 30 patients (34.1%) using embolization as the sole therapeutic technique. Mean volume reduction was 72% (range 30% - 100%) in 115 patients. Thirty four patients (38.6%, 34/88) underwent radiosurgical treatment. Additional embolization sessions were planned in 27 patients. Complications occurred in 19 patients (16.5%, 19/115), leading to death in one patient (mortality 0.9%) and permanent disabling in 3 patients (morbidity 2.6%).

CONCLUSIONSOnyx was shown to be feasible and safe for embolization of BAVMs. Proper use of the Onyx injection technique largely improved the endovascular treatment of BAVMs. Large AVMs can be adequately reduced in size through the use of additional treatment.

Adolescent ; Adult ; Arteriovenous Malformations ; pathology ; therapy ; Brain Diseases ; pathology ; therapy ; Child ; Child, Preschool ; Embolization, Therapeutic ; methods ; Female ; Humans ; Male ; Middle Aged ; Polyvinyls ; therapeutic use ; Treatment Outcome ; Young Adult

OBJECTIVETo study the angiographic properties of central AVMs in the jaw, and to investigate the efficacy of embolization of them.

METHODSEleven cases of central AVMs underwent angiography and embolization, nine cases experienced surgery after embolization, and the other two cases were embolized alone; all these cases were followed up after treatment. The angiographic features and embolization results were analyzed.

RESULTSLarge venous pouches were angiographically opacified in 9 of 11 AVMs. Of the nine operated cases, curettage was safely performed. The intraoperative bleeding was evidently decreased, and the continuity of the jaw was preserved. Five of these operated cases were free of recurrence during 18 - 27 months in follow-up. The two cases embolized alone were free of recurrence during 24 months' follow-up.

CONCLUSIONSVia arterial and venous approaches, embolization could greatly decrease the intraoperative bleeding and thus help to preserve the continuity and potentiality of development of the jaw for intraosseous AVMs, moreover, it may be curative in some cases.

Adolescent ; Arteriovenous Malformations ; pathology ; therapy ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Humans ; Jaw ; blood supply ; Male ; Mandible ; blood supply ; Maxilla ; blood supply ; Treatment Outcome

OBJECTIVETo report our experience to embolize the AVM of jaws by direct puncture in conjunction with endovascular treatment.

METHODS5 cases of AVM of mandible and 2 cases of AVM of maxilla comprised this study group. The patients were embolized with coils with wool strands and PVA. The coils were placed directly into the center of the intraosseous lesion. The procedure was under the guidance of DSA machine (PHILIPS V3000).

RESULTSThe acute arterial bleeding of 4 patients was controllable. The chronic oozing bleeding in the other 3 cases disappeared in the 3 - 24 months follow-up and new bone formation was found in the follow-up radiography.

CONCLUSIONSThe embolization of the AVM of jaws by direct puncture in conjunction with endovascular therapy is effective and safe, however the longer follow-up is expected.

Adolescent ; Arteriovenous Malformations ; pathology ; therapy ; Child ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Humans ; Jaw ; blood supply ; Male ; Mandible ; blood supply ; Maxilla ; blood supply ; Middle Aged ; Punctures ; Time Factors ; Treatment Outcome