Embolization therapy in the management of congenital arteriovenous malformations

Eight patients with congenital arteriovenous malformations (AVMs) underwent staged transcatheter arterial embolization. Six patients had AVMs involving an extremity, one had multiple pulmonary AVMs, and one had an AVM of the pancreas. Embolization was performed using Ivalon (polyvinyl alcohol) particles and Gianturco coils. Clinical course, fever pattern, and appropriate enzymatic laboratory studies were monitored. Leukocytosis occurred in all but one patient following embolization. A febrile course with the temperature reaching 39.6 degrees C without evidence of infection was seen in several patients for 3 to 5 days postembolization. Marked elevation in the creatine phosphokinase level and positive fibrin split products were noted in several instances. Because embolizations were performed in stages, serial arteriography was available. Embolization resulted in a reduction in symptoms in all eight patients and allowed a more limited surgical procedure than would otherwise have been possible in two patients. Complications occurred in three patients and are described. It is concluded that transcatheter arterial embolization is a useful therapeutic alternative in the management of congenital AVMs.