Ethanol embolotherapy of high-flow auricular arteriovenous malformations with electrolytically detachable coil-assisted dominant outflow vein occlusion.
Ethanol embolotherapy of high-flow auricular arteriovenous malformations with electrolytically detachable coil-assisted dominant outflow vein occlusion.
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DOI：
10.1016/j.ejvs.2014.08.004
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发表时间：
2014-11
期刊：
影响因子：
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通讯作者：
Deng-Bin Wang;L. Su;Yi-feng Han;X. Fan
中科院分区：
文献类型：
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作者：
Deng-Bin Wang;L. Su;Yi-feng Han;X. Fan
目的以流出静脉（DOV）为主的高流量动静脉畸形（AVM）仍然难以进行乙醇栓塞治疗，但可脱性弹簧圈的技术和经验的改进使其中一些AVM的治疗获得了令人满意的结果。报道了电解可脱性弹簧圈（EDC）辅助DOV闭塞用于高流量耳廓AVM的乙醇栓塞的技术和临床安全性以及有效性的单中心经验和评价，由于其可控制的部署，重新定位和移除，因此与传统弹簧圈相比具有一些优势。40例连续的耳部AVM患者接受了分期乙醇栓塞，其中9例患者的耳部AVM伴DOV，接受了高流量耳部AVM的乙醇栓塞联合EDC辅助DOV闭塞，并进行了回顾性评价。所有患者均完成了临床随访（范围，5 - 29个月;平均15.1个月），6例患者的影像学随访结果（范围，7 - 25个月;平均14.7个月）可从末次治疗中获得。通过评估症状和体征的临床结果，以及在后续arteriography.Results28乙醇栓塞和9 EDC辅助DOV闭塞的程度确定治疗结果进行了9例。在9名患者中使用了17种EDCs。9例患者中5例（55.6%）治愈，4例（44.4%）部分缓解。9例患者中有1例发生了轻微并发症。在28例手术中的9例中，9例患者中有6例发生一过性血红蛋白尿。没有出现重大并发症。结论在EDCs闭塞DOV的帮助下，乙醇栓塞在治疗高流量耳部AVM方面具有治愈的潜力，轻微和重大并发症的风险可接受。
ObjectivesHigh-flow arteriovenous malformations (AVMs) with a dominant outflow vein (DOV) remain difficult for ethanol embolotherapy, but improved technology and experience of detachable coils allows for the treatment of some of these AVMs with satisfactory results. A single-center experience and evaluation of technical and clinical safety, and effectiveness of electrolytically detachable coil (EDC)-assisted DOV occlusion for ethanol embolization of high-flow auricular AVMs, which has some advantages over conventional coils because of its controlled deployment, reposition, and removal is reported.MethodsFrom November 2010 to June 2013, 40 consecutive patients with auricular AVMs underwent staged ethanol embolizations, of which nine patients' auricular AVMs with a DOV who had undergone ethanol embolization of high-flow auricular AVMs in combination with EDCs-assisted DOV occlusion were retrospectively evaluated. Clinical follow-up (range, 5–29 months; mean, 15.1 months) was completed in all patients, and results from imaging follow-up (range, 7–25 months; mean, 14.7 months) were available from the last treatment session in six patients. Therapeutic outcomes were determined by evaluating the clinical outcome of symptoms and signs, as well as the degree of devascularization at follow-up arteriography.ResultsTwenty-eight ethanol embolizations and nine EDC-assisted DOV occlusions were performed in nine patients. Seventeen EDCs were used in nine patients. Five (55.6%) of the nine patients were cured, and four (44.4%) had partial palliation. One minor complication occurred in one of the nine patients. Transient hemoglobinuria occurred in six of nine patients in a total nine of the 28 procedures. There were no major complications.ConclusionsEthanol embolization has the potential for cure in the management of high-flow auricular AVMs with the aid of occlusion DOV by EDCs with acceptable risk of minor and major complications.