Department of Radiology, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
Department Oral Maxillofacial and Head-Neck Oncology Surgery, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
Eur J Vasc Endovasc Surg. 2014 Nov;48(5):576-84. doi: 10.1016/j.ejvs.2014.08.004. Epub 2014 Sep 16.
High-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.
From 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.
Twenty-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.
Ethanol 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.
高流量动静脉畸形（AVM）伴优势流出静脉（DOV）仍然难以进行乙醇栓塞治疗，但可脱性弹簧圈技术和经验的改进允许对其中一些 AVM 进行治疗，并取得满意的效果。本文报告了单中心经验，评估了电解可脱性弹簧圈（EDC）辅助 DOV 闭塞在乙醇栓塞治疗高流量耳 AVM 中的技术和临床安全性及有效性，与传统线圈相比，EDC 具有可控的展开、重新定位和移除等优点。
2010 年 11 月至 2013 年 6 月，40 例耳 AVM 患者接受了分期乙醇栓塞治疗，其中 9 例耳 AVM 伴 DOV 的患者在接受高流量耳 AVM 乙醇栓塞治疗的同时，还接受了 EDC 辅助 DOV 闭塞治疗。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 例患者的最后一次治疗随访获得了影像学随访结果（范围 7-25 个月；平均 14.7 个月）。治疗结果通过评估症状和体征的临床结果以及随访动脉造影的去血管化程度来确定。
9 例患者共进行了 28 次乙醇栓塞和 9 次 EDC 辅助 DOV 闭塞治疗。9 例患者共使用了 17 枚 EDC。5 例（55.6%）患者治愈，4 例（44.4%）患者部分缓解。9 例患者中有 1 例出现 1 例轻微并发症。在 28 例手术中，有 9 例共 9 例患者出现短暂性血红蛋白尿。无重大并发症。
在 EDC 辅助 DOV 闭塞的帮助下，乙醇栓塞治疗高流量耳 AVM 具有治愈的潜力，且具有可接受的轻微和重大并发症风险。
