Introduction: The transvenous approach is new strategy for endovascular management for brain Arteriovenous
Malformation (AVM). This technic allows a hight rate of total occlusion with low complications
when compared with others approaches. The compression of venous injection technique
and the proprieties of liquid embolic agent justify the success of this approach.
Objective: Confirm the the safe and great effectiveness of transvenous approach embolization
for selective AVMs. Method: Retrospective analysis for all AVMs treated with venous
approach in a reference center in France between May 2017 and November 2017 with review
and compression of treatment strategy. Results: Among the analyzed period, 170 patients
with 172 AVMs were treated in this institution; 50 patients with 51 AVMs (30%) were
treated by venous approach. In this selects group, the venous approach was the last
session in all AVMs, 01 patient were death secondary an initial intracerebral hematoma
with no complication in the treatment. 48 (94,1%) AVMs have angiogram control in 6
months and the total occlusion was achieved in 47 (92,1%). The total procedure-related
complications were 3 (6%), 2 hemorrhagic and 1 ischemic, only 01 patient has significant
disability (mRS 4). The hight rates of total occlusion with few complication can be
explained by patient selection, the injection technique and the comportment of the
liquid embolic agent (retrograde nidal/arterial penetration and late venous occlusion).
All AVMs were treated with non-adhesive liquid embolic agent comprised of EVOH (ethylene
vinyl alcohol), that retrograde penetrations permit occlusion of artery pedicles with
low pressure and little arterial reflux that permit lower ischemic rate. The EVOH
property of progressive laminar wall deposition, called “The Porcelain Vein”, permit
vein protection and later venous occlusion. The venous occlusion only happens after
total exclusion of the nidus and arterial pedicles, avoiding AVM rupture.
Conclusion: This series representing the result of reference neuroradiology center in France
and the safe of venous approach when well indicated. The hight rates of cure, 94.7%,
with few complications make the venous approach part of strategy in AVM management.
