Embolization of arteriovenous malformations by direct percutaneous puncture

Permanent control of arteriovenous malformations requires obliteration of the intrinsic vasculature of the lesion with a nonresorbable occlusive material. When tortuous feeding arteries prevent successful catheter positioning, it may be possible to percutaneously puncture the malformation with a Chiba needle for direct embolization with cyanoacrylate. Three illustrative cases are presented. In each, previous surgical ligation of feeding vessels was ineffective and embolization by catheter was not possible when the fistula recurred. Direct puncture of one or more feeding vessels with occlusion by cyanoacrylate controlled these fistulas, two of which were massive. No complications occurred.