3:18 PM Abstract No. 103 Balloon-assisted Onyx embolization of high-flow peripheral arteriovenous malformations with dual-lumen coaxial balloon microcatheter: technical aspects and clinical results

Abstract

The aim of this study was to demonstrate our experience in balloon-assisted Onyx (ethylene vinyl alcohol copolymer) embolization of high-flow peripheral arteriovenous malformations (AVMs) using dual-lumen coaxial balloon microcatheter technique, which does not necessitate a plug formation around the catheter that is required to allow antegrade flow of Onyx while preventing reflux and non-target embolization. This study expands the technique with its utilization on types of AVMs not described previously. Three patients with peripheral high-flow AVMs treated with balloon-assisted Onyx embolization using dual-lumen coaxial balloon microcatheter were retrospectively analyzed. AVMs were located in the kidney, pelvis, and chest wall. One patient required two sessions of Onyx embolization treatment. A total of 4 sessions were performed with Onyx 18 and/or Onyx 34 using Scepter XC occlusion balloon catheter. Imaging and clinical follow-ups were performed for all patients. Technical success was achieved in all patients. Complete devascularization was obtained in two patients with renal and pelvic AVMs with one treatment, while the patient with chest wall AVM required two sessions, which resulted in complete devascularization. There was no evidence of excessive reflux of Onyx or entrapment of the microcatheter. Non-target Onyx embolization or microcatheter fracture was not observed. After the final treatment, all patients were free of symptoms on clinical follow-up, and there was no evidence of recurrence identified on follow-up imaging. From our single-institutional experience, the technique using dual-lumen coaxial balloon microcatheter for balloon-assisted Onyx embolization appears to be safe and effective in treating high-flow peripheral AVMs, while allowing more precise injection of Onyx with the capability to reduce the risks associated with reflux of Onyx.