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

OBJECTIVETo compare the efficacy, clinical characteristics, safety, injection time and radiation exposure of Onyx embolization using a long-distance injection method and routine injection method for management of dural arteriovenous fistula (DAVF).

METHODSThe clinical data were retrospectively analyzed in 59 patients with DAVF treated with Onyx embolization using long-distance injection method (28 patients) and routine injection method (31 patients). The efficacy, safety, injection time and radiation exposure during Onyx embolization were compared between the two injections methods.

RESULTSThe average radiation dose exposure to the surgeon per procedure was significantly lower in the long-distance injection group than in the routine group. The injection time (P=0.53), injection volume (P=0.78), number of supply arteries (P=0.80), Cognard types (P=0.67), and effect of embolization (P=0.88) were all similar between the two groups.

CONCLUSIONEndovaseular treatment of intracranial DAVF with Onyx embolization using the long-distance injection method is feasible, safe and effective and can reduce the radiation exposure to the surgeon.

Arteries ; Central Nervous System Vascular Malformations ; therapy ; Dimethyl Sulfoxide ; therapeutic use ; Embolization, Therapeutic ; Humans ; Polyvinyls ; therapeutic use ; Retrospective Studies ; Treatment Outcome

OBJECTIVECongenital arteriovenous malformations(AVM) are considered to be the most difficult and challenging problems in the treatment of hemangiomas and vascular lesions. This study focused on the natural history, the clinical classification, the choice and effectiveness of various treatments.

METHODSThis retrospective review included 83 patients with extracranial arteriovenous malformations, who were referred to our department over the past 6 years. The anatomic patterns, clinical staging, respective treatments, influential factors of endovascular treatment, causes of recurrence were analyzed.

RESULTSAccording to clinical manifestations, arteriovenous malformations were categorized as three clinical stages: the quiescence, the expansion and the decompensation stages. Most AVMS in the quiescence stage only require endovascular treatment while those in the decompensation stage require surgical resection. Angiography was performed not only for diagnosis of AVM but also as an initial therapeutic step in the form of embolization, which might be the only means to some AVM without surgical possibility or necessity.

CONCLUSIONThe new concept of staging and management is expected to be helpful for diagnosis and treatments of AVM.

Acrylates ; therapeutic use ; Angiography ; Arteriovenous Malformations ; classification ; surgery ; therapy ; Embolization, Therapeutic ; Endoscopes ; Female ; Follow-Up Studies ; Humans ; Male ; Polyvinyls ; therapeutic use ; Retrospective Studies ; Treatment Outcome

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 evaluate the feasibility, efficacy and safety of a new method for distant injection of Onyx for treatment of intracranial arteriovenous malformations (AVMs).

METHODSThe clinical data of 26 patients with AVMs receiving distant injection of Onyx using the new method were retrospectively analyzed. Onyx was injected by the surgeon in the control room through a pressure transmission system.

RESULTSThe 26 patients received a total of 31 embolization procedures, with an average estimated size reduction of AVMs of (61.48 ± 26.85)%. Total obliteration was achieved in 3 AVMs. In one case, Onyx leakage occurred during the operation resulting from a broken microcatheter, and the patient developed hemiparesis after the operation.

CONCLUSIONEndovascular treatment of intracranial AVMs with Onyx embolization using this new distant injection method is feasible, safe and effective. This method minimizes potential radiation exposure of the surgeons without increasing the risks of related complications.

Adolescent ; Adult ; Aged ; Child ; Dimethyl Sulfoxide ; administration & dosage ; therapeutic use ; Embolization, Therapeutic ; methods ; Female ; Humans ; Intracranial Arteriovenous Malformations ; therapy ; Male ; Middle Aged ; Polyvinyls ; administration & dosage ; therapeutic use ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo observe the clinical and pathological characteristics of brain arteriovenous malformations (BAVM) embolized with the non-adhesive aqueous embolic agent Onyx and evaluate its application in comprehensive treatment of BAVM.

METHODSThirty-four patients underwent BAVM embolization using Onyx, and their clinical manifestations, architecture of the malformed vessels, emblization procedure, and complications associated with the procedures were recorded. The resected tissues after embolization with Onyx were observed with electron microscope, and the prognosis of the patients was estimated with modified Rankin Score (mRS).

RESULTSThese patients included 21 male and 13 female patients with a mean age of 30.45-/+11.81 years and an estimated mean size of the nidus of 3.98-/+1.43 cm. The patients received a total of 52 endovascular treatment procedures with Onyx to embolize 86 feeding pedicals, which resulted in an average estimated size reduction of the nidus of (72.35-/+21.26)%. Complications associated with the procedure occurred in 7 patients, and 23 patients received surgical resection or radiosurgery after embolization. Follow-up of the patients for 6 months to 4 years showed that the mRS was below 3 in 32 cases and > or =3 in 2 cases. Vasodilatation, brain tissue edema surrounding the nidus, and inflammatory cell infiltration were observed in the resected tissues after embolization. In some major feeding pedicals, thrombus recanalization was observed after embolization with Onyx (diameter> or =3 mm).

CONCLUSIONEndovascular treatment of BAVM with Onyx can achieve high occlusion rate, enhance the safety of operation and radiosurgery, and improve the clinical prognosis of the patients.

Adolescent ; Adult ; Aged ; Child ; Dimethyl Sulfoxide ; therapeutic use ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Humans ; Intracranial Arteriovenous Malformations ; surgery ; therapy ; Male ; Middle Aged ; Polyvinyls ; therapeutic use ; Young Adult

OBJECTIVE: To evaluate the therapeutic efficacy of a new liquid embolic materi-al,Embol, in embolization of the renal artery. MATERIALS AND METHODS: Embol is a new embolic material obtained by partial hydrolysis of polyvinyl acetate mixed in absolute ethanol and Iopromide 370 and manufactured by Schering Korea, Kyonggido, Korea. Six patients who underwent embolization of the renal artery using Embol were evaluated. Four were male and two were female and their ages ranged from 11 to 70 (mean, 53) years. Clinical and radiologic diagnoses referred for renal artery embolization were renal cell carcinoma (n = 3), renal angiomyolipoma (n = 2) and pseudoaneurysm of the renal artery (n = 1). After selective renal angiography, Embol was injected through various catheters, either with or without a balloon occlusion catheter. Changes in symptoms and blood chemistry which may have been related to renal artery embolization with Embol were analyzed. RESULTS: The six patients showed immediate total occlusion of their renal vas-cular lesions. One of the three in whom renal cell carcinoma was embolized with Embol underwent radical nephrectomy, and the specimen thus obtained revealed 40% tumor necrosis. In the two patients with angiomyolipomas, the tumors decreased in size and abdominal pain subsided. Bleeding from pseudoaneurysm of the renal artery was successfully controlled. Four patients showed symptoms of post-embolization syndrome, and one of these also showed increased levels of blood urea nitrogen and creatinine. One patient experienced transient hyperten-sion. CONCLUSION: Embol is easy to use, its radiopacity is adequate and it is a safe and effective embolic material which provides immediate and total occlusion of renal vascular lesions.
Aged ; Aneurysm, False/therapy ; Angiomyolipoma/therapy ; Carcinoma, Renal Cell/therapy ; Child ; *Embolization, Therapeutic ; Ethanol ; Female ; Human ; Iohexol/*analogs & derivatives ; Kidney Neoplasms/*therapy ; Male ; Middle Age ; Polyvinyls/therapeutic use ; *Renal Artery