EMBOLIZATION THERAPY OF CONGENITAL ARTERIOVENOUS-MALFORMATIONS - USE OF ALTERNATE APPROACHES

PURPOSE: To present results of embolization therapy performed with use of alternate approaches in 22 patients with peripheral congenital vas cular malformations in whom lesion anatomy precluded effective use of conventional transfemoral catheter techniques. MATERIALS AND METHODS: Eleven patients had high-flow fistulous arteriovenous malformations an d 11 had hemangiomatous vascular malformations. The alternate approach es employed were direct injection of embolic materials into the malfor mation or into central vessels of the lesion under fluoroscopic guidan ce and (in four cases) selective catheterization and embolization of a bnormal veins draining arteriovenous malformations. The primary emboli c agent combination used consisted of polyvinyl alcohol particles, sod ium tetradecyl sulfate, microfibrillar collagen, and ethanol. RESULTS: Use of alternate approaches resulted in effective symptomatic control in 10 of 11 patients (91%) with hemangiomatous lesions and seven of 1 1 (64%) with high-flow arteriovenous malformations. CONCLUSION: Use of alternate approaches to such vascular malformations extends the use o f embolization therapy.