Ethanol Embolotherapy of High-flow Auricular Arteriovenous Malformations with Electrolytically Detachable Coil-assisted Dominant Outflow Vein Occlusion

Abstract

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.