Embolization of High Flow Arteriovenous Malformations: Experience with Use of Superabsorbent Polymer Microspheres
Section snippets
Embolic Material
The SAP-MS (sodium acrylate and vinyl alcohol copolymer; Fig 1)isan embolic agent designed for use in the treatment of hypervascular tumors and AVMs. This material is a nontoxic and nonbiodegradable solid particle with a spherical shape. The particle size is calibrated in increments of approximately 50 μm (range, 53–350 μm; ie, 53–106,106 –150,150 –212,212–250, 250 –300,300 –350 μm). The SAP-MS absorbs fluids and swells within several minutes. The diameter of a SAP-MS particle in an ionic
RESULTS
Seventy-two TAE procedures were performed in all patients (range, 1–11, mean, 2.8 per patient) and 12 DPE procedures were performed in four patients (range, 1–3, mean, 1.8 per patient). SAP-MS particles were used in 71 of 72 TAE procedures (99%). In only one TAE procedure in one patient with LE-AVM, SAP-MS particles were not used because of a large arteriovenous fistula that was occluded with coils. SAP-MS particles were always easily delivered through a microcatheter and no catheter occlusion
UE-AVMs
In UE-AVMs (n = 8), pain (n = 5) and swelling (n = 8) were dominant symptoms. Intractable ulceration was seen in three cases and was accompanied by bleeding in two cases. In two cases with finger AVM, TAE treatment failed to improve the symptoms and both fingers were amputated. In one case of hand AVM, the lesion was prominent on the palm and severely painful. TAE treatment followed by DPE of the nidi with use of 1% polidocanol resulted in shrinkage of the lesion with pain relief. In three
LE-AVMs
In LE-AVMs (n = 12), pain (n = 10) and swelling (n = 11) were dominant symptoms in addition to skin ulcer (n = 4), bleeding (n = 1), and discoloration (n = 1). Pain relief was obtained by embolotherapy alone in nine cases and all of these patients walked well without restriction. Ulcer was intractable in two cases. In one case of foot AVM, the infiltrative diffuse AV shunting was noted on DSA. The painful ulcer was not controlled by TAE treatment and the patient was lost at 21-month follow-up
DISCUSSION
Efficacy of transarterial or direct puncture embolization for AVMs has been reported with use of various embolic agents including PVA (13, 14, 15, 16, 17), NBCA (7, 18, 19), ethanol (8), and others (20, 21). Although most of them were considered to be “effective” in short-to mid-term follow-up, there have been few reports describing long-term efficacy of each agent.
In the current study, the authors described their experience with use of SAP-MS particles in the management of facial and extremity
Acknowledgments
The authors thank Robert I. White, Jr., MD, for his editorial assistance, and Saki Osuga, MD, Fumiaki Isohashi, MD, and Ms. Yukari Tanaka for their help in the preparation of this manuscript.
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None of the authors has identified a conflict of interest.