Systemic Hemodynamic Changes in Low-Dose Ethanol Embolotherapy for Soft-Tissue Arteriovenous Malformations

Abstract

Ethanol embolotherapy is considered an optimal choice for the treatment of arteriovenous malformations (AVMs); however, there are some complications associated with this treatment. This study aimed to prospectively investigate systemic hemodynamic changes in high-flow AVMs using ethanol embolotherapy. From September 2012 to September 2014, 34 male patients and 26 female patients with AVMs who underwent embolotherapy (100 sessions in total) with absolute ethanol were included in this study. Invasive systolic blood pressure (SBP) and heart rate (HR) were recorded before and after each injection and throughout the procedure. Differences between the initial and highest SBP (ΔmaxSP) and HR values (ΔmaxHR), as well as the initial and final SBP (ΔSP) and HR (ΔHR) values, were analyzed. We aimed to explore the potential association between these values and the amount of ethanol that was used. The total ethanol used was variable (0.01–0.40 mL/kg; mean, 0.20 mL/kg). SBP and HR increased after ethanol injection in most sessions (91 in 100 sessions). SBP decreased in 9 sessions (9 in 100 sessions), while HR, oxygen saturation, and end-tidal CO2 decreased in one of the 9 sessions. ΔmaxSP and ΔmaxHR averaged 38.4 mmHg and 27.8 bpm, respectively (both P<0.05), while ΔSP and ΔHR averaged 3.4 mmHg and 4.0 bpm, respectively (both P<0.05). ΔmaxSP and ΔmaxHR were positively correlated with the total dose of ethanol injected. Elevations in SBP and HR during ethanol embolotherapy are common, temporary, and most likely pain-mediated; these increases tend to be positively correlated with ethanol dose. Hypotension may be regarded as an acute complication of ethanol embolotherapy. Hypotension combined with bradycardia, oxygen desaturation, and decreased end-tidal CO2 may be a potential predictor of cardiovascular collapse.