Transvenous Embolization Technique for Brain Arteriovenous Malformations

Muhammad Waqas; Ammad A Baig; Elad I Levy; Adnan H Siddiqui

doi:10.1016/j.nec.2021.11.001

Transvenous Embolization Technique for Brain Arteriovenous Malformations

Neurosurg Clin N Am. 2022 Apr;33(2):185-191. doi: 10.1016/j.nec.2021.11.001. Epub 2022 Mar 2.

Authors

Muhammad Waqas¹, Ammad A Baig¹, Elad I Levy², Adnan H Siddiqui³

Affiliations

¹ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY 14203, USA.
² Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY, USA.
³ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY 14203, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY, USA. Electronic address: asiddiqui@ubns.com.

PMID: 35346450
DOI: 10.1016/j.nec.2021.11.001

Abstract

Transvenous embolization is potentially curative for small AVMs with favorable anatomic features, such as inaccessible arterial feeders, deep location, and/or a single draining vein. Successful embolization requires the control of arterial blood flow and successful navigation of the draining vein. This allows permeation of the embolizate into the nidus. Arterial inflow may be controlled using a hypercompliant balloon or systemic hypotension. We have described the use of transvenous rapid ventricular pacing and adenosine to achieve transient controlled hypotension. This requires a multidisciplinary approach, yet provides high chances of complete obliteration of the AVM.

Keywords: Brain arteriovenous malformation; Rapid ventricular pacing; Transient transvenous pacing; Transvenous embolization technique.

Publication types

Review

MeSH terms

Brain
Embolization, Therapeutic* / methods
Humans
Intracranial Arteriovenous Malformations* / therapy