Embolization therapy of congenital arteriovenous malformations: use of alternate approaches

To present results of embolization therapy performed with use of alternate approaches in 22 patients with peripheral congenital vascular malformations in whom lesion anatomy precluded effective use of conventional transfemoral catheter techniques.

Eleven patients had high-flow fistulous arteriovenous malformations and 11 had hemangiomatous vascular malformations. The alternate approaches employed were direct injection of embolic materials into the malformation or into central vessels of the lesion under fluoroscopic guidance and (in four cases) selective catheterization and embolization of abnormal veins draining arteriovenous malformations. The primary embolic agent combination used consisted of polyvinyl alcohol particles, sodium tetradecyl sulfate, microfibrillar collagen, and ethanol.

Use of alternate approaches resulted in effective symptomatic control in 10 of 11 patients (91%) with hemangiomatous lesions and seven of 11 (64%) with high-flow arteriovenous malformations.

Use of alternate approaches to such vascular malformations extends the use of embolization therapy.