Feeding pedicles

In some centers, a complete diagnostic pulmonary angiography is performed prior to embolotherapy [78]. Selective injections in right and left pulmonary arteries in standard, oblique, and lateral projections are obtained. Outpatient pulmonary angiography in patients with diffuse PAVMs provides a basis for deciding which side to occlude first, to detail the anatomy, determine the best projection for occluding the PAVMs, and measure the feeding pedicles which helps to select the occlusion technique [76, 78]. 

There are still two situations in which Onyx should not be used today direct fistula, in which the Onyx cannot occlude solely a high-flow large shunt because it is not adhesive, and a feeding pedicle en passage , in which reflux on the tip of the... 

Table 4.5. Expected feeding pedicles, recommended selective injections, and projections for intracranial dural arteriovenous malformations (DAVMs) in different locations...

The treatment of spinal DAVM by surgery is easy, safe, and effective and requires interruption of the draining vein at its dural entrance only (Anson and Spetzler 1992). Therefore, embolization of spinal DAVM should be offered only if the feeding pedicle provides a safe approach to a position close to the fistula site and it does not give rise to radiculomedullary branches supplying the anterior spinal artery. If there is a risk of reflux into the anterior spinal artery, surgery is significantly safer and should be performed. 

Antlers are grown and shed annually from two points on the front or side of the skull. During the growing season, an antler is covered with skin and fine hair. Blood vessels feed the bony mass, which grows from the ends and around the surface. As an antler nears its maximum size, the blood supply is gradually cut off and the velvet coating dries and sloughs off. After a short time, a sinus opens between the basal burr on the skull and the bottom of the antler. The ander is then dropped, and a scar forms on the pedicle. 

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