Systematic Review of Transcatheter Arterial Embolization of AVM: Indications, Bleeding Complications, Cure Rate, and Long-Term Bleeding Risk.

Abstract

This study was to assess the proportion of patients that have bleeding complications, cure rates, and long-term bleeding events for each of the indications (monotherapy, pre- stereotactic radiosurgery (SRS), and presurgery) for AVM embolization. Published literature in the PubMed database by May 2016 citing embolization results for AVMs using liquid embolic agents was reviewed. Additional studies were identified through reference searches in each reviewed article. A systematic review was performed to evaluate the bleeding complications, cure rate, and long-term bleeding risk. We identified 30 studies, including 5103 patients. The overall cure rate was 18%. Curative embolization was achieved in 24% of monotherapy, 10% of pre-surgical, and 16% after pre-SRS. In the Onyx group, the cure rate was higher of 25% ( χ2 = 6.25, P < 0.025). Multiple session (≥2) associated with a higher cure rate of 23% (χ2 = 10.53, P < 0.005). The overall bleeding complication rate of transarterial embolization was 5%. The case fatality of bleeding complication was 31%. Onyx and pre-SRS embolization have a higher bleeding complication rate of 8%. The small studies reported a higher cure rate and bleeding complication rate than large studies. Onyx has increased the cure rate and bleeding complication rate of AVM embolization. Multiple sessions are associated with a higher cure rate and do not increase the bleeding complication. Current pre-SRS AVM embolization has a higher bleeding complication rate. There are publication biases between small and large studies.