Interventional Radiology Department, AORN Cardarelli di Napoli, Via A. Cardarelli 9, 80131, Naples, Italy.
Radiol Med. 2019 Feb;124(2):154-162. doi: 10.1007/s11547-018-0948-6. Epub 2018 Oct 27.
High-flow arteriovenous malformations (AVMs) are complex vascular lesions for which transcatheter embolization is considered as first-choice treatment nowadays. Multiple embolizing agents have been described, and among them, Onyx seems to be promising; this is a liquid embolic agent, originally applied in neurointerventional radiology and recently adopted also in peripheral embolizations. The aim of this study is to report on a 10-year experience of transarterial embolization of peripheral high-flow AVM with Onyx in terms of technical and clinical outcomes.
Retrospective analysis was conducted on patients affected by high-flow AVM and treated electively by transarterial embolization with Onyx. Data collection included: preinterventional clinical radiological evaluations, procedural data and post-procedural clinical radiological assessment. Technical and clinical success was evaluated; follow-up was conducted 30 days after the last treatment session and yearly in case of success.
Sixteen patients have been included, totally 38 embolizing procedures. Additional embolizing agents were required in 5 patients. Technical success was obtained in 11 patients; at 30-day follow-up, 15 patients showed improvements in symptoms, even those with incomplete embolization; however, after almost 1 year from treatment accomplishment, 7 patients showed relapse of symptoms and presented radiological signs of AVM recurrence. No clinically relevant complications occurred.
In this series, in accordance with previous but limited published data, Onyx appeared safe and technically effective to embolize high-flow peripheral AVM with transarterial approach. Clinical radiological follow-up is mandatory because new feeder recruitment has to be expected; patients should be informed of the concrete possibility of multiple treatment sessions.
高流量动静脉畸形（AVM）是复杂的血管病变，目前经导管栓塞被认为是首选治疗方法。已经描述了多种栓塞剂，其中 Onyx 似乎很有前途；这是一种液体栓塞剂，最初应用于神经介入放射学，最近也用于外周栓塞。本研究旨在报告 10 年来用 Onyx 经动脉栓塞治疗外周高流量 AVM 的技术和临床结果。
对接受 Onyx 经动脉栓塞选择性治疗的高流量 AVM 患者进行回顾性分析。数据收集包括：术前临床影像学评估、手术数据和术后临床影像学评估。评估技术和临床成功；在最后一次治疗后 30 天进行随访，如果成功则每年进行随访。
共纳入 16 例患者，共进行了 38 次栓塞治疗。5 例患者需要额外的栓塞剂。11 例患者获得了技术上的成功；在 30 天随访时，15 例患者的症状得到改善，即使是那些栓塞不完全的患者；然而，在治疗完成近 1 年后，7 例患者出现症状复发，并出现 AVM 复发的影像学征象。没有发生临床相关的并发症。
在本系列中，与之前有限的已发表数据一致，Onyx 经动脉途径栓塞外周高流量 AVM 是安全且技术有效的。必须进行临床影像学随访，因为预计会有新的供血动脉募集；应告知患者多次治疗的具体可能性。
