Transvenous retrograde AVM embolization: Indications, techniques, complications and outcomes

Area of Science:

• Interventional Neuroradiology
• Vascular Neurology
• Neurosurgery

Background:

• Arteriovenous malformations (AVMs) pose significant neurological risks.
• Transvenous retrograde arteriovenous malformation embolization (TRAE) is an emerging endovascular technique.

Purpose of the Study:

• To review the techniques, combinations, and effectiveness of TRAE for AVM treatment.
• To analyze outcomes of TRAE based on existing literature.

Main Methods:

• Systematic literature search of PubMed and Web of Science for studies on TRAE.
• Analysis of 16 eligible studies encompassing 60 AVM cases treated with TRAE.
• Review of prior treatments, procedural details, and patient outcomes.

Main Results:

• Complete AVM obliteration was achieved in 93.3% of cases.
• Prior treatments included transarterial embolization (Onyx, cyanoacrylate), coiling, neurosurgery, or radiosurgery to reduce nidus size.
• Good functional outcomes (mRS ≤ 2) were observed in 90% of patients at follow-up.
• Ruptured AVMs and Spetzler-Martin grades I-III showed high cure rates.

Conclusions:

• TRAE is a safe and curative option for selected AVMs.
• Optimal results are achieved when TRAE is preceded by treatments that sufficiently reduce nidus size.
• The technique can be performed with or without proximal arterial temporary balloon protection.