Classification of Arteriovenous Malformation and Therapeutic Implication

Yakes, Wayne F.; Yakes, Alexis M.

doi:10.1007/978-88-470-5673-2_33

Cited by 18 publications

(18 citation statements)

References 21 publications

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“…A transvenous or percutaneous approach to the nidus area is highly indicated. Total outflow occlusion, preferably with controlled retrograde nidus embolisation with a liquid embolic, is the most effective strategy [9,10]. We believe that in our case, combined arterial embolisation of the largest feeder subsequently to venous embolisation slowed down the flow within the nidus and venous aneurysm and led to total AVM thrombosis.…”

Section: Discussionmentioning

confidence: 79%

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Endovascular therapy of arteriovenous malformation in a male patient with severe post-coital pelvic pain

et al. 2019

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Purpose Congenital pelvic arteriovenous malformations (AVMs) are high-flow vascular lesions consisting of abnormal shunts between arteries and veins within a nidus. The rare presentation and extensive network of vasculature contributes to the difficulty in effective treatment. Optimal therapeutic options are determined based on the clinical presentation, the location of the lesion, and possible complications. Case report A 24-year-old male patient with a history of recurrent pain following sexual intercourse presented with complaints of intense pelvic pain radiating to the perineal area. Computed tomography angiography (CTA) revealed a large venous aneurysm as an outflow vein of a right-sided pelvic AVM. Embolisation of the outflow veins was established along with direct percutaneous delivery of fibre coils and thrombin to the venous aneurysm of the AVM. With recurring symptoms and AVM recanalisation on angiography, another direct puncture and placement of pushable coils was made. Total AVM occlusion was achieved with no recanalisation on follow-up digital subtraction angiography (DSA), and the patient remained asymptomatic. Conclusions Endovascular embolisation of the nidus area may result in a complete occlusion of an AVM. Therefore, a thorough understanding of the vascular anatomy of the AVM is essential in choosing an effective embolisation strategy and to minimise the risk of possible complications.

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Section: Discussionmentioning

confidence: 79%

“…The presenting pelvic AVM was classified as Yakes type IIIb, consisting of multiple feeding arteries and arterioles with a nidus in the aneurysmal vein wall with further multiple outflow veins [9]. A transvenous or percutaneous approach to the nidus area is highly indicated.…”

Section: Discussionmentioning

confidence: 99%

Endovascular therapy of arteriovenous malformation in a male patient with severe post-coital pelvic pain

et al. 2019

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“…1,4,6,7,10 The Yakes AVM classification system provides a useful guide for treatment planning that may require retrograde and DSE primary treatment approaches (Table). 5,8,9,11 Whereas ultimately the route of therapy is determined by the experienced operator, certain AVM configurations lend themselves more effectively to certain therapeutic modalities over others. For example, Yakes Ia AVMs represent a more direct fistulous connection between the involved artery and vein.…”

Section: Discussionmentioning

confidence: 99%

“…She had presented with a diagnostic angiogram from an outside facility, which had confirmed a Yakes IIb AVM with an intervening nidus situated between arterial feeders from the radial artery and degenerated draining veins into the superficial cephalic system (Fig 1; Table). 8,9 Technical details. A 5F short sheath was placed antegrade into the brachial artery at the elbow.…”

Section: Patientmentioning

confidence: 99%

Direct stick embolization of extremity arteriovenous malformations with ethylene vinyl alcohol copolymer

Nassiri

Cirillo-Penn

Crystal

2017

Journal of Vascular Surgery

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Direct stick embolization (DSE) of high-flow peripheral arteriovenous malformations (AVMs) has previously been reported using n-butyl cyanoacrylate and ethanol. The use of ethylene vinyl alcohol copolymer (Onyx; Covidien, Plymouth, Minn) through this delivery route has been extremely limited, particularly in the peripheral interventional realm, owing to concerns about technique and conduit for delivery, skin discoloration, and ulceration. We describe three patients with relatively focal, symptomatic, congenital high-flow AVMs of the upper and lower extremity treated successfully by multifaceted approaches including transvenous coil embolization of the nidus venous outflow, transarterial embolization, and DSE of the AVM nidus with Onyx. Successful delivery of Onyx into the AVM nidus was achieved without nontarget embolization. Sustained symptomatic relief without recurrence or associated complications was achieved at 1 month, 3 months, and 6 months of follow-up. Nidus embolization is a key technical maneuver for optimal treatment of high-flow AVMs, although it is not always easily achievable by the transarterial route in more extensive, convoluted angioarchitectural varieties. With appropriate technical considerations and precautionary measures, Onyx can be safely and effectively delivered through DSE into the AVM nidus with satisfactory short-term and midterm clinical outcomes. This maneuver expands the armamentarium of the treating vascular surgeon facing complicated peripheral AVMs.

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“…A lack of understanding for hemodynamic characteristics of various AVM types has led to incorrect therapeutic approaches with high complication rates described in the literature 4,5 . Although various classification systems were proposed 6,7 , there are microfistular, high-flow malformations not fitting into the established schemes 8 .…”

Section: Introductionmentioning

confidence: 99%

Capillary-venule malformation is a microfistulous variant of arteriovenous malformation

Vuillemin

Bernhard

Haine

et al. 2021

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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Classification of Arteriovenous Malformation and Therapeutic Implication

Cited by 18 publications

References 21 publications

Endovascular therapy of arteriovenous malformation in a male patient with severe post-coital pelvic pain

Endovascular therapy of arteriovenous malformation in a male patient with severe post-coital pelvic pain

Direct stick embolization of extremity arteriovenous malformations with ethylene vinyl alcohol copolymer

Capillary-venule malformation is a microfistulous variant of arteriovenous malformation

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