The efficiency of transvenous access for embolization of convexital cerebral arteriovenous malformations
Introduction. Convexital localization of cerebral arteriovenous malformations (AVM) is a good prognostic criterion for successful endovascular treatment. Difficulties begin in the final stages of large AVMs, in the transit nature of afferents. Transvenous embolization has been developed as an alternative to microsurgery and radiosurgery for a limited range of malformations. Materials, methods, results. January 2011 - December 2016, the National Medical Research Center treated 440 patients with cerebral arteriovenous malformations who underwent more than 1200 embolization sessions. From this number, a transvenous access to the AVM was performed in 43 patients. AVMs were localized in the cerebral cortex of 12 patients; in 2 of them (17 %) the transvenous embolization was the single treatment option; the rest of the patients required 2 to 4 preliminary transarterial staged embolizations. In the group, no lethal outcomes and significant persistent neurological deficit were recorded. Total deactivation was achieved in 9 patients (75 %); 2 patients (16.7 %) required microsurgical removal of residual AVM network; in 1 patient (8.3 %), radiosurgical treatment was performed. Discussion. Comparing the results of transvenous treatment of convexital malformations with an of patients treated with the classic transarterial technique, no statistically significant difference (p > 0.05) in morbidity and mortality was achieved. The total occlusion rate of transvenous embolization is significantly higher (p < 0.05). Conclusions. A gradual expansion of indications for the transvenous access increases the efficiency of surgical treatment of this pathology without significantly increasing the risks of adverse outcomes. This access should only be used in centers with significant experience of transarterial embolization.