Late Recurrence After Angiographic Cure of Pediatric Arteriovenous Malformations Treated by Transvenous Embolization

Pediatric brain arteriovenous malformations (AVMs) have higher recurrence rates than adult lesions, yet the long-term durability of transvenous embolization (TVE) in children remains poorly defined. We therefore evaluated long-term clinical and angiographic outcomes after curative TVE for ruptured pediatric AVMs.

This multicenter retrospective cohort comprised 12 pediatric patients (older than 18 years) treated with curative TVE from 2012 to 2025. Angiographic cure was defined as complete obliteration on 6-month digital subtraction angiography (DSA). Long-term surveillance included annual MRI/magnetic resonance angiography, with confirmatory DSA if recurrence was suspected.

Complete angiographic obliteration was achieved in all patients at 6 months. Over a mean follow-up of 103 ± 39 months, no delayed hemorrhages occurred. Late AVM recurrence was identified in 2 patients (17%) after documented angiographic cure and was detected only on delayed imaging surveillance. One recurrence involved a lesion with previous superficial venous drainage, whereas the other occurred in a lesion with deep venous drainage. Both were successfully retreated endovascularly without added morbidity.

TVE provides durable hemorrhage control in selected pediatric AVMs; however, late recurrence may still occur despite early angiographic cure. These findings confirm that TVE is no exception to the well-documented late recurrence rate of pediatric AVMs across all treatment modalities, reinforcing that prolonged imaging surveillance is as essential after TVE as after microsurgery or radiosurgery.