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Updated: Aug 8, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Curative embolization of ruptured pediatric cerebral arteriovenous malformations
Aaron Rodriguez-Calienes1, Juan Vivanco-Suarez2, Nagheli Fernanda Borjas-Calderón3
1Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru.
Insights
Curative embolization of pediatric ruptured arteriovenous malformations (AVMs) shows moderate obliteration rates but carries risks of recurrence and complications. Lesions under 2 cm are more amenable to complete obliteration via endovascular management.
Area of Science:
- Vascular Surgery
- Pediatric Neurology
- Interventional Radiology
Background:
- Curative embolization for ruptured arteriovenous malformations (AVMs) is not extensively studied, particularly in pediatric cases.
- The efficacy and safety of primary curative embolization for pediatric AVMs remain uncertain.
Purpose of the Study:
- To evaluate the safety and efficacy of curative embolization in pediatric patients with ruptured AVMs.
- To identify predictors of successful obliteration and procedure-related complications.
Main Methods:
- Retrospective analysis of pediatric patients (≤18 years) undergoing curative embolization for ruptured AVMs between 2010 and 2022.
- Assessment of complete angiographic obliteration, recurrence rates, and safety outcomes (complications, mortality).
Main Results:
- Complete angiographic obliteration was achieved in 62% of 68 pediatric patients after a median follow-up of 18 months.
- Recurrence occurred in 13% of cases, with 11.9% experiencing procedure-related complications; no deaths were reported.
- Nidus size > 2 cm was the sole independent predictor of incomplete obliteration (OR = 0.16; p = 0.030).
Conclusions:
- Curative embolization offers acceptable obliteration rates for pediatric ruptured AVMs but requires careful consideration of recurrence and complications.
- Pediatric ruptured AVMs ≤ 2 cm demonstrate suitability for complete obliteration through curative endovascular management.
Introduction:
Embolization with the intention to cure has not been well studied in ruptured arteriovenous malformations (AVMs). Furthermore, the role of primary curative embolization of pediatric AVMs is uncertain. Hence, we aimed to characterize the safety and efficacy of curative embolization of ruptured pediatric AVMs and assess predictors of obliteration and complications.
Methods:
A retrospective analysis of all pediatric (≤18 years) patients who underwent curative embolization of ruptured AVMs was conducted in two institutions between 2010 and 2022. The efficacy (complete angiographic obliteration after the last embolization session), recurrence (radiological recurrence of the lesion after confirmed obliteration in follow-up imaging), and safety (procedure-related complications and mortality) of the procedure were evaluated.
Results:
Sixty-eight patients (38 females; mean age 12.4 ± 3.4 years) underwent a total of 109 embolization sessions. Median follow-up time was 18 months after embolization (ranged from 2 to 47 months). Complete angiographic obliteration was achieved in 42 patients (62%). In 30 patients (44%) the AVM was occluded with a single embolization session. Recurrence of a totally embolized lesion occurred in 9 patients (13%). Thirteen complications (11.9% of procedures) were observed, and no deaths were reported. A nidus size > 2 cm was the only independent predictor of complete obliteration (OR = 0.16; 95% CI 0.03 - 0.77; p = 0.030).
Conclusion:
Embolization of pediatric ruptured AVMs with curative intent can achieve acceptable obliteration rates. However, recurrence after complete obliteration and procedure-related complications of curative embolization of these lesions cannot be ignored. Ruptured AVMs ≤ 2 cm are adequate to achieve complete obliteration with curative endovascular management.
