Transvenous to arterial Onyx embolization.

Area of Science:

• Interventional Neuroradiology
• Vascular Malformations
• Embolization Techniques

Background:

• Transarterial Onyx embolization is standard for arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs).
• Transvenous Onyx embolization is infrequently used, primarily for carotid cavernous fistulas.
• A novel transvenous Onyx embolization technique for high-risk DAVFs and vein of Galen (VOG) AVMs is presented.

Purpose of the Study:

• To describe a novel transvenous Onyx embolization technique.
• To evaluate its safety and efficacy in treating complex cerebral vascular malformations.
• To assess clinical indications and potential complications.

Main Methods:

• Standard transfemoral venous approaches were used to access draining venous systems.
• Microcatheters were navigated into arterial feeder ostia via the draining venous pouch.
• Onyx was infused to achieve retrograde embolization of multiple feeders.

Main Results:

• Four female patients (5 months to 68 years) with high-risk DAVFs and a VOG AVM were treated.
• Successful embolization of multiple feeders from a single transvenous infusion was achieved.
• Complete cure in three patients and significant AVM nidus reduction in one patient were observed, with no complications.

Conclusions:

• Transvenous Onyx infusion can effectively embolize multiple arterial feeders supplying complex DAVFs and cerebral AVMs.
• This technique is safe and potentially curative in select cases of high-risk vascular malformations.
• The described method offers a viable alternative for challenging AVM and DAVF treatments.