“…Despite significant advances in endovascular embolization technologies and techniques – including the development of advanced microcatheter systems and liquid embolysates such as n-butyl cyanoacrylate (n-BCA) glue (Trufill®, Cerenovus, Irvine, CA, USA) and DMSO based ethylene vinyl alcohol co-polymer (Onyx®, Medtronic, Minneapolis, MN, USA), VOGMs remain very technically challenging lesions ( 1 , 3 – 8 ). While this is due to number of factors, the most significant is the difficulty associated with successful on-target deposition of embolic material at the fistulous site in the setting of the very high-flow arteriovenous shunt.…”