Acute Respiratory Distress Syndrome after Onyx Embolization of Arteriovenous Malformation

Tawil, Isaac; Carlson, Andrew P.; Taylor, Christopher L.

doi:10.1155/2011/918185

Cited by 16 publications

(11 citation statements)

References 11 publications

(10 reference statements)

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“…Onyx is less thrombogenic than NBCA, and larger amounts of Onyx than of NBCA are therefore required for complete occlusion of type III shunts. Complications are rare, but serious pulmonary complications such as pulmonary embolism and acute respiratory distress syndrome have been associated with Onyx embolization (31).…”

Section: Type III Nontraumatic Renal Av Shuntsmentioning

confidence: 99%

Renal Arteriovenous Shunts: Clinical Features, Imaging Appearance, and Transcatheter Embolization Based on Angioarchitecture

Maruno¹,

Kiyosue

Tanoue³

et al. 2016

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Renal arteriovenous (AV) shunt, a rare pathologic condition, is divided into two categories, traumatic and nontraumatic, and can cause massive hematuria, retroperitoneal hemorrhage, pain, and high-output heart failure. Although transcatheter embolization is a less-invasive and effective treatment option, it has a potential risk of complications, including renal infarction and pulmonary embolism, and a potential risk of recanalization. The successful embolization of renal AV shunt requires a complete occlusion of the shunted vessel while preventing the migration of embolic materials and preserving normal renal arterial branches, which depends on the selection of adequate techniques and embolic materials for individual cases, based on the etiology and imaging angioarchitecture of the renal AV shunts. A classification of AV malformations in the extremities and body trunk could precisely correspond with the angioarchitecture of the nontraumatic renal AV shunts. The selection of techniques and choice of adequate embolic materials such as coils, vascular plugs, and liquid materials are determined on the basis of cause (eg, traumatic vs nontraumatic), the classification, and some other aspects of the angioarchitecture of renal AV shunts, including the flow and size of the fistulas, multiplicity of the feeders, and endovascular accessibility to the target lesions. Computed tomographic angiography and selective digital subtraction angiography can provide precise information about the angioarchitecture of renal AV shunts before treatment. Color Doppler ultrasonography and time-resolved three-dimensional contrast-enhanced magnetic resonance angiography represent useful tools for screening and follow-up examinations of renal AV shunts after embolization. In this article, the classifications, imaging features, and an endovascular treatment strategy based on the angioarchitecture of renal AV shunts are described.

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Section: Type III Nontraumatic Renal Av Shuntsmentioning

confidence: 99%

Renal Arteriovenous Shunts: Clinical Features, Imaging Appearance, and Transcatheter Embolization Based on Angioarchitecture

Maruno¹,

Kiyosue

Tanoue³

et al. 2016

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“…At our institution, NBCA glue is preferred over Onyx, because Onyx utilization typically extends the embolization 29 and requires more fluoroscopic time, 49 which potentially increases the detrimental effects of ionizing radiation on children's developing nervous systems. Furthermore, the potentially large doses of Onyx required for embolization of these fistulas increases the risk for the rare complication of DMSO (dimethyl sulfoxide)-related pulmonary toxicity 39,46 associated with Onyx. This pulmonary toxicity may exacerbate the preexisting cardiovascular and pulmonary comorbidities often seen in this group of children.…”

mentioning

confidence: 99%

An institutional series and literature review of pial arteriovenous fistulas in the pediatric population

Madsen¹,

Lang²,

Pisapia³

et al. 2013

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Object Pial arteriovenous fistulas (PAVFs) are a rare form of cerebrovascular disease that tend to be overrepresented in the pediatric population. There have been limited studies of the clinical features and outcomes in this group of patients. Here, the authors attempt to better delineate this clinical entity with institutional cases and a review of the literature. Methods A retrospective review of cases at our institution was performed to identify all pediatric patients treated for a PAVF between 2000 and 2012. Results Five patients treated for a PAVF were identified. Patients had a mean age of 1.9 years at diagnosis, and the most common presenting symptoms were seizure and macrocephaly. Patients were treated primarily with embolization, and 3 patients required both N-butyl cyanoacrylate (NBCA) glue and coiling. Four of the patients had complete obliteration of the PAVF and had a pediatric overall performance category score of either 1 (n = 3) or 2 (n = 1) at follow-up. There was 1 death due to heart failure. Analysis of the literature review suggested that a younger age or presence of intracerebral hemorrhage (ICH) or congestive heart failure (CHF) at presentation likely predicts a worse prognosis. Older patients presented more often with ICH, whereas younger patients presented significantly more often in CHF. The majority of pediatric patients reported on in the literature were treated with endovascular embolization, most commonly with NBCA glue alone. Most patients (65.4%) in the literature had an excellent outcome without neurological deficit. Conclusions Pial AVFs represent a serious yet rare form of cerebrovascular disease. Pediatric patients with ICH or CHF at presentation or those who are very young are likely to have a worse prognosis. Endovascular management of these patients has greatly changed the natural history of this disease, but the complication and mortality rates suggest the need for continued insights and advances in treatment.

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“…However, the possible toxicity of DMSO on blood vessels was still unclear. 16 DMSO may evoke an inflammatory response and endothelial necrosis following intra-arterial injection and dissipation of the DMSO in the blood stream, and then led to potential toxicity to blood vessels both at the site of injection and may result in the post-procedural hemorrhage. 16 Hence, moderate Onyx volume and slow Onyx injection rate were recommended.…”

Section: Conducted a Systematic Reviewmentioning

confidence: 99%

Hemorrhagic risk factors of endovascular onyx embolization of intracranial dural arteriovenous fistulas

et al. 2020

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Background and purpose Hemorrhagic complication is a disastrous complication of intracranial dural arteriovenous fistulas (DAVFs) embolization. This study was to analyze the possible risk factors for the hemorrhagic complication caused by endovascular embolization of DAVFs. Methods From January 2012 to July 2016, a total of 267 patients with intracranial DAVFs received endovascular Onyx embolization at our hospital. The demographic information, clinical presentation, angiographic features, endovascular treatment and hemorrhagic complications were reviewed. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors contributing to the post-procedural hemorrhagic complications. Results In 267 patients of DAVF treated with endovascular embolization, procedure-related hemorrhagic complication occurred in 12 (4.5%) patients. Univariate and multivariate logistic regression analyses showed that the pial arterial supplier (OR 13.630; 95% CI, 1.556–119.368; P = 0.018), giant venous aneurysm (OR 15.196; 95% CI, 2.505–92.183; P = 0.003) and Onyx volume ≥ 6 ml (OR 1.138; 95% CI, 1.006–1.288; P = 0.040) were significant factors associated with these hemorrhagic complications. Conclusions Hemorrhagic complications associated with endovascular DAVF embolization are not negligible. The pial arterial supplier, giant venous aneurysm and higher Onyx volume in one session may be risk factors for endovascular DAVF embolization.

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Acute Respiratory Distress Syndrome after Onyx Embolization of Arteriovenous Malformation

Cited by 16 publications

References 11 publications

Renal Arteriovenous Shunts: Clinical Features, Imaging Appearance, and Transcatheter Embolization Based on Angioarchitecture

Renal Arteriovenous Shunts: Clinical Features, Imaging Appearance, and Transcatheter Embolization Based on Angioarchitecture

An institutional series and literature review of pial arteriovenous fistulas in the pediatric population

Hemorrhagic risk factors of endovascular onyx embolization of intracranial dural arteriovenous fistulas

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