Embolization of peripheral high-flow arteriovenous malformations with Onyx

Kilani, M. Saeed; Lepennec, V.; Petit, Philippe; Magalon, G.; Casanova, Dominique; Bartoli, Jean-Michel; Vidal, Vincent

doi:10.1016/j.diii.2016.06.017

Cited by 40 publications

(25 citation statements)

References 30 publications

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“…Complete devascularization was obtained in the most cases (58%) including the 12 patients with subsequential surgical resection. These results are similar to previously published studies of embolotherapy of extracranial AVMs [6,17,18], though there has to be noted that in our cohort a higher percentage received subsequent surgical resection (41%). While using EVOH-based liquid agents in most procedures we found an overall and major complication rate of 24% and 18%, respectively.…”

Section: Discussionsupporting

confidence: 93%

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Schmidt

Masthoff

Brill

et al. 2022

Cardiovasc Intervent Radiol

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Purpose To evaluate the safety and outcome of image-guided embolotherapy of extracranial arteriovenous malformations (AVMs) primarily affecting the face. Materials and Methods A multicenter cohort of 28 patients presenting with AVMs primarily affecting the face was retrospectively investigated. Fifty image-guided embolotherapies were performed, mostly using ethylene–vinyl alcohol copolymer-based embolic agents. Clinical and imaging findings were assessed to evaluate response during follow-up (symptom-free, partial relief of symptoms, no improvement, and progression despite embolization), lesion devascularization (total, 100%; substantial, 76–99%; partial, 51–75%; failure, < 50%; and progression), and complication rates (classified according to the CIRSE guidelines). Sub-analyses regarding clinical outcome (n = 24) were performed comparing patients with (n = 12) or without (n = 12) subsequent surgical resection after embolotherapy. Results The median number of embolotherapy sessions was 2.0 (range, 1–4). Clinical outcome after a mean follow-up of 12.4 months (± 13.3; n = 24) revealed a therapy response in 21/24 patients (87.5%). Imaging showed total devascularization in 14/24 patients (58.3%), including the 12 patients with subsequent surgery and 2 additional patients with embolotherapy only. Substantial devascularization (76–99%) was assessed in 7/24 patients (29.2%), and partial devascularization (51–75%) in 3/24 patients (12.5%). Complications occurred during/after 12/50 procedures (24.0%), including 18.0% major complications. Patients with subsequent surgical resections were more often symptom-free at the last follow-up compared to the group having undergone embolotherapy only (p = 0.006). Conclusion Image-guided embolotherapy is safe and effective for treating extracranial AVMs of the face. Subsequent surgical resections after embolization may substantially improve patients’ clinical outcome, emphasizing the need for multimodal therapeutic concepts. Level of Evidence Level 4, Retrospective study.

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Section: Discussionsupporting

confidence: 93%

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Schmidt

Masthoff

Brill

et al. 2022

Cardiovasc Intervent Radiol

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“…In 2016, Kilani et al [ 32 ] demonstrated by embolizing a cohort of 19 patients with extra cranial AVMs how the use of non-adhesive embolizing fluids could provide controlled embolization due to slow polymerization enabling deep penetration in the nidus with less risk of catheter gluing due to its non-adhesive nature associated with a high rate of clinical success and low rate of complication.…”

Section: Arterio-venous Malformationmentioning

confidence: 99%

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

Piacentino

Fontana

Curti

et al. 2021

JCM

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This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been published recently and the aim of this review is to explore and analyze this field of application. There are a few NALEA liquids such as Onyx, Squid, and Phil currently available in the market, and they are used in the following applications: mainly arteriovenous malformations, endoleaks, visceral aneurysm or pseudoaneurysm, presurgical and hypervascular lesions embolization, and a niche of percutaneous approaches. These types of embolizing fluids can be used alone or in combination with other embolizing agents (such as coils or particles) so as to enhance its embolizing effect or improve its possible defects. The primary purpose of this paper is to evaluate the use of NALEAs, predominantly used alone, in elective embolization procedures. We did not attempt a meta-analysis due to the data heterogeneity, high number of case reports, and the lack of a consistent follow-up time period.

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“…There have been described some cases of DMSO toxicity, including life-threatening complications as hemolysis, pulmonary edema, and renal failure after AVM embolization using EVOH, which may be dose related. 102 Further complications reported after EVOH embolization are procedure-related embolic events, 103 skin necrosis, or local infections, the third may potentially induce consecutive EVOH extrusion.…”

Section: Interventional Treatment Optionsmentioning

confidence: 99%

Interventional Treatment Options in Children with Extracranial Vascular Malformations

et al. 2022

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Extracranial vascular malformations vary greatly and belong to the complex field of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic system. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) represents an important guidance for selecting appropriate therapy. Although many of the principles of endovascular treatment, including image-guided sclerotherapy and embolization, are similar in adult and pediatric practice, there are some distinct differences regarding the treatment of vascular malformations of children. Thus, it is crucial to involve longer-term plan about managing these chronic diseases and their impact on a growing child. This review provides a detailed overview over the clinical presentation of venous, lymphatic, and arteriovenous malformations in children and emphasizes the specifics of their interventional treatment options, including distinct pediatric dose limitations and procedure-related side effects.

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Embolization of peripheral high-flow arteriovenous malformations with Onyx

Abstract: Embolization with Onyx is an interesting option for management of peripheral high-flow AVMs either preoperatively or as a single treatment.

Cited by 40 publications

References 30 publications

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

Interventional Treatment Options in Children with Extracranial Vascular Malformations

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