AVM embolization

AVM embolization is normally accomplished through transfemoral microcatheter delivery of the material under fluoroscopic guidance. The microcatheter tip is placed where the feeding artery branches off from healthy vasculature and... 

N-butyl cyanoacrylate is the most commonly used cerebral AVM embolic material, and is considered by some to be the most effective (Finfante and Wakhloo, 2007). While its drawbacks include tissue adhesiveness and optimization of polymerization time, the main advantage of this material is its permanency. The curative capability of n-BCA, seen both after initial embolization... 

The procedure for Onyx administration in an aneurysm is similar to the plug and push technique described for AVM embolization, but with the additional consideration of inflation and deflation of the balloon during the procedure such that blood flow in the parent artery is not restricted for an extended period of time. Overall, this may tend to increase procedure times when embolizing aneurysms with Onyx as opposed to coil embolization. 

Becker T A, Preul M C, Bichard, W D, Kipke D R and McDougall C G (2005), Calcium alginate gel as a hiocompatible material for endovascular AVM embolization six-month results in an animal model , Neurosurgery, 56, 793-801. 

The major risk of brain AVM embolization is acute postembolization hemorrhage (APEH). APEH is both the most frequent and the most neurologically devastating complication of embolization. Ischemic complications due to inadvertent embolization of normal arteries feeding adjacent brain parenchyma is much more rare and is associated with a better neurologic outcome. 

Many complications are reported particularly with alcohol embolization, such as pulmonary embolus, cardiovascular collapse, neuropathy, skin blisters, radiculopathy, finger numbness, and focal skin necrosis [23, 24]. Arterial line monitoring and Swan-Ganz catheters are recommended for large AVM embolization [24] (Figs. 23.6a-d, 23.7a-d). 

In children with gastrointestinal arteriovenous malformations, the angiographic examination confirms the diagnosis and the extent of the AVMs. Embolization is usually not recommended in small bowel and colonic lesions because of the risk of necrosis [32, 33]. Embolotherapy is sometimes considered preoperatively to lower the risk of operative bleeding. 

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