Lv Xianli, Song Cao, He Hongwei, Jiang Chuhan, Li Youxiang
1 Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, People's Republic of China.
2 Neurosurgery Department, Jilin Center Hospital, People's Republic of China.
Interv Neuroradiol. 2017 Oct;23(5):504-509. doi: 10.1177/1591019917716817. Epub 2017 Jul 4.
Objective Transvenous retrograde arteriovenous malformation (AVM) embolization (TRAE) has been proposed. The present study was to review the techniques, their conjunctions and effectiveness. Methods Eligible related articles were identified by searching the PubMed and Web of Science databases using "transvenous" and "arteriovenous malformation." Results A total of 16 eligible studies, with 60 cases of AVM treated with TRAE, were analyzed. Prior to TRAE procedure, transarterial Onyx 18 was performed in 23 (38.3%), cyanoacrylate in three (5%) and coiling in two (3.3%), neurosurgery in one (1.7%) and radiosurgery in three (5%). These prior treatments were used to reduce the size of the nidus to <3 cm and TRAE was performed. One anterior choroidal artery aneurysm was coiled before TRAE. Systemic hypotension (blood pressure<100 mmHg) occurred in six (10%) patients and local hypotension (proximal arterial temporary balloon protection) in five (8.3%) patients. Complete obliteration was achieved in 56 (93.3%) AVMs, four (6.7%) with residual, of which one was supplemented with radiosurgery. During mean one-year follow-up (1 month to 3.2 years), there were five cases (8.3%) of permanent disability and one (1.7%) mortality resulting from initial hemorrhage. Fifty-four (90%) patients were independent (mRS ≤ 2) at follow-up. Ruptured AVMs and Spetzler-Martin I-III were associated with a high cure rate. Conclusion According to previous reports, selected AVMs could undergo TRAE. TRAE is safe and curative with Onyx after the nidus size is reduced sufficiently by transarterial embolization, neurosurgery or radiosurgery, with or without the aid of proximal arterial temporary balloon protection.
目的 已提出经静脉逆行动静脉畸形（AVM）栓塞术（TRAE）。本研究旨在回顾其技术、联合应用及有效性。方法 通过在PubMed和Web of Science数据库中检索“经静脉”和“动静脉畸形”来确定符合条件的相关文章。结果 共分析了16项符合条件的研究，其中60例AVM接受了TRAE治疗。在TRAE手术前，23例（38.3%）进行了经动脉Onyx 18栓塞，3例（5%）进行了氰基丙烯酸酯栓塞，2例（3.3%）进行了弹簧圈栓塞，1例（1.7%）进行了神经外科手术，3例（5%）进行了放射外科手术。这些前期治疗用于将病灶大小缩小至<3 cm后再进行TRAE。1例脉络膜前动脉瘤在TRAE前进行了弹簧圈栓塞。6例（10%）患者出现全身性低血压（血压<100 mmHg），5例（8.3%）患者出现局部低血压（近端动脉临时球囊保护）。56例（93.3%）AVM实现了完全闭塞，4例（6.7%）有残留，其中1例补充了放射外科治疗。在平均1年的随访期（1个月至3.2年）内，有5例（8.3%）患者因初始出血导致永久性残疾，1例（1.7%）死亡。54例（90%）患者在随访时独立（改良Rankin量表评分≤2）。破裂的AVM和Spetzler-Martin I-III级与高治愈率相关。结论 根据既往报道，部分AVM可进行TRAE。在经动脉栓塞、神经外科手术或放射外科手术充分缩小病灶大小后，无论是否借助近端动脉临时球囊保护，使用Onyx进行TRAE是安全且有效的。
