Transarterial embolization of peripheral high-flow arteriovenous malformation with ethylene vinyl alcohol copolymer (Onyx®): single-center 10-year experience

• Published in: Radiologia medica 2019-02, Vol.124 (2), p.154-162
• Main Authors: Giurazza, Francesco, Corvino, Fabio, Cangiano, Gianluca, Cavaglià, Errico, Amodio, Francesco, Silvestre, Mattia, De Magistris, Giuseppe, Niola, Raffaella
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arteriovenous Malformations - therapy; Contrast Media; Data acquisition; Diagnostic Radiology; Embolization, Therapeutic - methods; Female; Humans; Imaging; Interventional Radiology; Lesions; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Patients; Polyvinyls - therapeutic use; Radiology; Reagents; Retrospective Studies; Signs and symptoms; Success; Tomography, X-Ray Computed; Treatment Outcome; Ultrasound; Vascular and Interventional Radiology
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-018-0948-6

Purpose High-flow arteriovenous malformations (AVMs) are complex vascular lesions for which transcatheter embolization is considered as first-choice treatment nowadays. Multiple embolizing agents have been described, and among them, Onyx ® seems to be promising; this is a liquid embolic agent, originally applied in neurointerventional radiology and recently adopted also in peripheral embolizations. The aim of this study is to report on a 10-year experience of transarterial embolization of peripheral high-flow AVM with Onyx ® in terms of technical and clinical outcomes. Materials and methods Retrospective analysis was conducted on patients affected by high-flow AVM and treated electively by transarterial embolization with Onyx ® . Data collection included: preinterventional clinical radiological evaluations, procedural data and post-procedural clinical radiological assessment. Technical and clinical success was evaluated; follow-up was conducted 30 days after the last treatment session and yearly in case of success. Results Sixteen patients have been included, totally 38 embolizing procedures. Additional embolizing agents were required in 5 patients. Technical success was obtained in 11 patients; at 30-day follow-up, 15 patients showed improvements in symptoms, even those with incomplete embolization; however, after almost 1 year from treatment accomplishment, 7 patients showed relapse of symptoms and presented radiological signs of AVM recurrence. No clinically relevant complications occurred. Conclusions In this series, in accordance with previous but limited published data, Onyx ® appeared safe and technically effective to embolize high-flow peripheral AVM with transarterial approach. Clinical radiological follow-up is mandatory because new feeder recruitment has to be expected; patients should be informed of the concrete possibility of multiple treatment sessions.