Color doppler ultrasound study of the embolism and sclerotherapy of fibrin glue combined with bleomycin for the treatment of cervicofacial vascular malformations / 实用口腔医学杂志

Objective:To explore the mechanism of the embolism and sclerotherapy of fibrin glue combined with bleomycin (FG/BLM) for the treatment of cervicofacial vascular malformations by color doppler ultrasound.Methods:10 patients with venous malformation(VM) and 10 patients with arterio-venous malformation(AVM) were included.All patients underwent embolism and sclerotherapy of FG/BLM guided by ultrasound.Color doppler ultrasound was used to record the real-time two-dimensional ultrasonography and color doppler image.The flow and distribution of FG/BLM after injection into the lesions were observed.Results:Two-dimensional ultrasonography showed clumps or flake strong echo after immediate injection of FG/BLM into the cavity of VMs,then floated in the abnormal venous lumen and diffused throughout the cavity.At the later stage the lesions were filled by a large number of flocculent and netted low echo,and patchy strong echo.The volume of VMs cavity expanded dramaticlly,and the blood flow signal was significantly decreased.After injection of FG/BLM into the lumen of AVMs,clumps or flake strong echo were observed,then most of the snowflake strong echo rapidly filled or scattered along with blood stream to the distal part of the vessels.The color doppler showed significantly decrease of blood flow signal.Conclusion:FG/BLM injection can embolize and block the draining vein of VM,and play a role on the storage of sclerozing agent.FG/BLM injection can embolize both the dilated blood vessels and capillary network of AVM.

Renal Arteriovenous Malformation with Multiple Renal Artery Aneurysms Treated by Control of the Arterial Inflow Alone / 日本心臓血管外科学会雑誌

<p>Endovascular treatment is a first-line treatment for renal arteriovenous malformations (AVMs). Endovascular treatment might be effective in patients with aneurysmal-type renal AVMs, which involve one feeding artery and one drainage vein, because control of the feeding artery, rather than the aneurysm itself, could have a therapeutic effect. Herein, we describe two cases of patients with renal AVM with multiple renal artery aneurysms, who were treated by controlling the arterial inflow alone. In Case 1, the patient was a 76-year-old woman with renal AVM discovered during examination for another medical condition. A computed tomography scan revealed four renal aneurysms (φ38/44/24/35 mm) ranging from an intimal defect in the right renal artery to the drainage vein running into the inferior vena cava (IVC). Although we had planned to use a covered stent in the right renal artery to cover the intimal defect without embolization of the aneurysms, a minor artery proximal to the aneurysm was found near the orifice of the right renal artery. Therefore, we used a covered stent in the right renal artery after embolization of the most proximal aneurysm was performed. In Case 2, a 78-year-old man was referred to our facility because a renal AVM was found during examination for lower back pain. The distal posterior branch of the right renal artery attached to the multiple aneurysms and directly drained into the IVC, which was diagnosed as an aneurysmal-type renal AVM. Because there were no arteries arising from the aneurysms in the right renal artery, which fed the renal parenchyma, embolization of only the inflow artery was performed. For both patients, renal blood flow was maintained without any decrease of the renal function. In these patients, although renin-angiotensin system activity was within the normal range, and blood pressure became better controlled postoperatively. In addition, there was significant improvement in the brain natriuretic peptide (BNP) levels postoperatively. Thus, we believe that unstable hypertension and/or high-output heart failure as well as the aneurysmal size should be assessed in the management of renal AVMs.</p>

Resección quirúrgica de malformación arteriovenosa de alto flujo en ángulo nasogeniano con embolización preoperatoria: reporte de un caso / Surgical resection of high-flow arteriovenous malformation of the nasogenian sulcus with preoperatory embolization: a case report

El 50% de las malformaciones arteriovenosas (MAVs) de alto flujo se ubican en la región craneofacial y pueden producir sangrado con riesgo vital sin diagnóstico y tratamiento adecuado. La resonancia magnética (RM) es útil en el diagnóstico diferencial de las lesiones vasculares, siendo el gold standard la angiografía selectiva. Dado que las MAVs de alto flujo no involucionan espontáneamente, el tratamiento usualmente consiste en embolización con posterior resección quirúrgica. Se presenta un paciente de sexo masculino de 20 años que consulta por aumento de volumen nasogeniano derecho, progresivo, violáceo, blando y pulsátil. Se objetiva mediante RM una zona de vasos serpentiginosos, que se extiende desde el subcutáneo hasta la pared anterior del maxilar. La angiografía cerebral confirma MAV de alto flujo e informa mapeo vascular. Se decide embolización prequirúrgica superselectiva con posterior resección tumoral mediante acceso transvestibular.

The 50 % of arteriovenous malformations (AVMs) of high flow are located in the craniofacial region and can cause life-threatening bleeding without a diagnosis and appropriate treatment. Magnetic resonance imaging is useful in the differential diagnosis of vascular lesions, being the gold standard selective angiography. Since high-flowA VMs do not regress spontaneously, treatment usually involves surgical resection with subsequent embolization. We present a 20 years male patient consulting with a purple, progressive, soft, pulsating enlargement of right-side nasogenian region. Magnetic resonance imaging shows serpiginous vessels, extending from the subcutaneous to the anterior wall of the maxillary. Cerebral angiography confirms high flowAVM and shows vascular mapping. It was decided superselective preoperative embolization with subsequent tumor by transvestibular access.

Síndrome de malformaciones capilares-malformaciones arteriovenosas (CM-AVM) / -Capillary malformation syndrome arteriovenous malformation (CM-AVM)

El síndrome de malformaciones capilares-malformaciones arteriovenosas (CM-AVM) es una entidad descripta recientemente, que se caracteriza por la asociación de malformaciones capilares con malformaciones arteriales o fístulas arteriovenosas. Es de herencia autosómica dominante y se produce por mutaciones en el gen RASA1. Las malformaciones capilares en este síndrome presentan ciertas características particulares por lo que son llamadas atípicas. Algunas son congénitas y otras aparecen en forma progresiva. Presentan tamaño variable (desde lesiones puntiformes hasta de varios cm de diámetro), son rosadas o amarronadas, tienen aumento de temperatura local y están rodeadas por un halo pálido. En ocasiones comprometen mucosa oral. Es importante que el dermatólogo sea capaz de reconocer este síndrome, ya que en ocasiones puede asociarse con compromiso interno.

Capillary malformation-arteriovenous malformation is a recently described disorder, characterized by the association of capillary malformations with arterial malformation or arteriovenous fistulae. It is an autosomal dominant disease caused by mutations in RASA1. Capillary malformations in this syndrome are called atypical because they share some particular characteristics. Some are congenital and others appear progressively. They varied in size (from pinpoint lesions to several centimeters of diameter), are pink or brown, sometimes warmer than normal skin and are surrounded by a pale halo. Oral mucosa can be affected. It is important for the dermatologist to recognize this syndrome, taking in account that it can be associated to internal compromise.

Kimura’s Disease.

A rare case of Kimura’s disease alongwith AV Malformation around left pinna in a 26 year old male is being described. AV Malformation had two feeders from superficial temporal artery and occipital artery. The lesion was excised along with ligation of feeders. Post operatively patient was put on systemic corticosteroid therapy with some benefits.

Intracerebral hemorrhage after lung lobectomy in patients with congenital pulmonary artero-venous malformation (AVM).

A 13-year-old boy was diagnosed with isolated congenital pulmonary AV fistula at the left lower lobe of the lung. He was operated for left lower lobe lobectomy. 18 hours after the operation, the patient developed intracerebral and intraventricle hemorrhage with hydrocephalus and brain edema. As a result he was operated on again for a ventriculoperitoneal shunt. 5 months after the operation. Brain MRI was done and indicated a suspected AVM at pineal region. 6 months after the operation, he reported normal health condition and could regularly perform daily activities including exercises.

A treatment of atreiovenous malformation on mandible

The treatment of intraosseous ateriovenous malformation in the jaw is difficult because of life threatening frequent bleeding tendency. The surgical resection of AVM may be mortal due to massive blood loss .In the growing pediatric patient, surgery may cause facial deformity and growth disturbance. So currently, the treatment of AVM is only embolization using various material through endovascular access, direct-puncture or embolization in conjunction with surgical resection. We report a case of combined techniques.

Arteriovenous Malformation of the Scalp: Efficacy of Computed Tomography Angiography

We report a rare case of scalp arteriovenous malformation(AVM). A 55-year-old woman presented with a pulsatile palpable mass on her left temporo-parietal scalp. She complained of insomnia because of bruit, which was audible when she lay on her left side. Computed tomography angiography(CTA) for the scalp vessel showed AVM on the left temporo-parietal region. Multiple enlarged arteries, such as the superficial temporal artery, posterior auricular artery, and occipital artery, were directly connected to the elongated dilated superficial temporal vein. Digital subtraction angiography also showed similar results. Fistulous portions were clearly delineated on both modalities. Surgical excision of the malformations, including feeding arteries and the draining vein, resulted in immediate relief of the symptoms. Usefulness of CTA in the diagnosis of vascular lesions on the scalp was emphasized.

A case of hemosuccus pancreaticus in arteriovenous malformation / 대한내과학회지

Hemosuccus pancreaticus describes the syndrome of gastrointestinal bleeding into the pancreatic duct, manifested by blood loss through the ampulla of Vater. Pancreatic arteriovenous malformation (AVM), while extremely rare, are frequently complicated by gastrointestinal bleeding. Endoscopy is essential to rule out other causes of upper gastrointestinal bleeding. In rare cases, active bleeding is seen from the duodenal ampulla. Selective celiac angiography is the only diagnostic test. Angiography is always necessary to facilitate tactics of treatment, even if diagnosis has been established by non-invasive imaging modalities. To obtain complete regression, total extirpation of the affected organ, or at least the involved portion, should be performed before this disease leads to the lethal complications of gastrointestinal bleeding and portal hypertension. Transcatheter arterial embolization is the only alternative treatment for the control of hemorrhage. We experienced a patient with upper gastrointestinal bleeding in which the diagnosis of hemosuccus pancreaticus secondary to a AVM in chronic pancreatitis was diagnosed preoperatively. We report our experience with a review of literatures.

Hemodynamic Pathogenesis of AVM / 대한뇌혈관외과학회지

Significantly decreased perfusion pressure is common in vascular territories irrigating neuronal tissue in patients with AVMs. There is evidence that "adaptive autoregulatory displacement" occurs in these patients which maintains cerebral blood flow above ischemic levels. Chronic arteriolar vasodilatation does not usually lead to vasomotor paralysis because most patients maintain a constant cerebral blood flow in spite of increased systemic arterial pressure. AVM hemodynamics appears to play an important role in the etiology of spontaneous intracerebral hemorrhage. Large AVM with high-flow and severe arterial hypotension are least likely to hemorrhage. In patients with AVMassociated aneurysm, the etiology of these dual lesions is likely multifactorial, with hemodynamic stresses having a dominant influence.

A Case of Successful Transarterial Embolization (TAE) in Huge Arteriovenous Malformation (AVM) of Uterus / 대한산부인과학회잡지

A case of Cessation of massive vaginal bleeding after TAE in giant Arteriovenous Malformation (AVM) of the Uterus. A 68-year old woman who had massive vaginal bleeding was diagnosed of AVM of uterus by ultrasonogram, CT, MRI, and angiography. In our case report, we tried transarterial embolization 2 times by spring coils and detachable balloons. She was treated successfully by TAE resulting in prompt cessation of life- threatened vaginal bleeding. Color and duplex doppler US is an appropriate modality for the detection and diagnosis of uterine AVMs and for follow-up after embolization. Transarterial embolization is a safe and effective method of treating this disease.

A Case Report of Arteriovenous Malformation of Uterus / 대한산부인과학회잡지

Although arteriovenous malformation (AVM) of the uterus is a very rare cause of menometrorrhagia or postmenopausal vaginal bleeding, it is notable to think in the assessment of a woman with abnormal uterine bleeding because correct diagnosis can yield proper therapy to be designed and avoid hysterectomy in women who want to continue their reproductive capacity. AVM may be congenital or acquired. In times past, the diagnosis is usually made after hysterectomy, but currently it may be made before treatment by ultrasound, pelvic angiography, or magnetic resonance imaging. We have experienced one case of AVM of uterus, which is diagnosed after hysterectomy.

Thrombosed Cerebral Arteriovenous Malformation (AVM): Operative Case Report / 대한뇌혈관학회지

Spontaneously thrombosed cerebral arteriovenous malformations (AVM) are infrequently reported. Its pathophysiology, and natural course, however, are still not clarified yet. Authors report a case of symptomatic, spontaneously thrombosed cerebral AVM in a 34-year-old male with a follow-up of 16-year duration, which was surgically extirpated due to repeated bleeding and intractable seizure disorder, and histopathologically confirmed. Relevant literatures are reviewed and discussed.

Cerebral Arteriovenous Malformation Associated with Intracranial Meningioma and Aneurysm: Case Report

The cerebral arteriovenous malformation(AVM) rarely coexists with primary intracranial tumor. The authors experienced a patient with intracerebral hematoma due to AVM rupture in whom intracranial meningioma and intracranial aneurysms coexisted. The meningioma was located at convexity of right frontal lobe, and arteriovenous malformation at temporo-occipital lobe of same hemisphere with feeding from right middle cerebral artery, and three intracranial aneurysms exist at the cavernous portion of right internal carotid artery, AVM feeding artery, and intranidal of the AVM. The authors report a rare case of coexisted intracranial AVM, meningioma and aneurysms with review of literatures.

Intramedullary arteriovenous malformations: vascular architecture and endovascular embolization / 介入放射学杂志

Objective To study the vascular architecture and the indication of endovascular embolization of intramedullary AVMs and evaluate the therapeutic effect. Methods 15 patients (male 9 and female 6 , 9 to 43 years old) with acute or progressive paralysis were undergone DSA and endovascular embolization. The embolic material was PVA particles and silk suture segments. Lidocaine test was performed before embolization if it was necessary. Results There were 3 glomus AVMs and 12 juvenile AVMs among the 15 cases. The glomus AVM was usually fed by single artery, the juvenile AVM was fed by two or more arteries. Among 15 patients, 2 were cured, 3 had excellent effect, 6 had good effect, 4 showed no changed and no one became worsening. After 6 months to 5 years follow up, 7 patients with recurrency were re embolized,another 2 patients were lost of follow up. Conclusions Endovascular embolization is a mild invasive, safety and effective therapeutic method for curing AVMs by avascularizing the rudus and decreasing the drainage vein pressure and bleeding.

A Case of Endoscopic Band Ligation Therapy in Gastric Arteriovenous Malformation / 대한소화기내시경학회지

Although various endoscopic treatments, such as laser photocoagulation, electrocoagulation, heater probe, injection have been used for treatment of arteriovenous malformation (AVM), associated complications also have been reported. In order to avoid the complications, elastic band ligation has recently been used as an alternative method for endoscopic treatment of gastric AVM. A 58-year-old man was admitted due to hematemesis and melena. A gastroscopy revealed AVM with vessel exposure and active bleeding at the greater curvature of fundus, and we performed arteriography for emergency embolization, but, we do not find the bleeding vessel. Endoscopic band ligation therapy was performed as an alternative method for control of bleeding. 2 months later, follow-up endoscopy showed disappearance of AVM and no evidence of hemorrhage.

Management of Intracranial Small AVM / 대한뇌혈관학회지

For the management of small intracranial arteriovenous malformation(AVM), various methods were proposed and their clinical outcomes have been analyzed. Microsurgery, radiosurgery, and embolization can be effective for the treatment of small AVM. Small AVM is known to be at a higher risk of bleeding. Therefore, the aim of treatment should be the prevention of neurological deterioration from bleeding. Microsurgery has the advantage of prompt elimination of the risk of rebleeding by complete excision with single procedure. With the advance of microsurgical techniques, small AVM can be cured with minimal neurological deficit. Outcome of microsurgery depends on location, size, and numbers and patterns of draining veins, which mean Spetzler-Martin grades. Stereotactic device guided surgery, preoperative careful evaluation, intraoperative electrophysiological and hemodynamic monitoring, and experienced surgical skills can greatly reduce adverse brain injury and help complete and exact excision of malformations. Radiosurgery has its unique role for the deep seated AVM, but long term outcome remains to be evaluated. In the management of small AVM, surgery should be considered as the first line of treatment, and radiosurgery can be an alternative for the surgically inaccessible lesions.

Endovascular Treatment of Intracranial AVM / 대한뇌혈관학회지

Since 1983, we have experienced endovascular treatment of intracranial AVMs.2)3) Superselective catheterization of feeding artery, embolization or feeding artery occlusion of the cerebral AVMs have been performed for 73 cases in 134 sessions. Endovascular treatment of intracranial AVMs such as embolization or feeding artery occlusion have been performed for 57 cases of AVMs in 95 sessions. In each time, endovascular approach was performed for two to five feeding arteries, so more than 300 feeding arteries were catheterized by microcatheters or balloon catheters. In this report, we present our experiences of endovascular treatment of intracranial AVMs and discuss embolic materials and the role of endovascular treatment of intracranial. AVMs.

Surgery of Cerebrovascular Lesions Causing Intractable Epilepsy

OBJECTIVE: Traditionally, the main indications for surgery in vascular-related lesion were based upon reduction or control of seizures, reversal of symptoms of deficits related to mass effect, and prevention of hemorrhage or recurrent hemorrhage. However, the results of surgical treatment for seizure control are disappointing in some reports. Here we describe surgical strategies and our experience in treating patients with intractable seizures associated with vascular-related lesions according to sophisticated presurgical and intraoperative evaluation. METHODS: Twelve(4.5%) patients were selected for this study out of total 264 patients with resective epilepsy surgery at our epilepsy center during four years since 1992. All were treated with anticonvulsant agents but became refractory. These patients operated on under local or general anesthesia for resection surgery, underwent presurgical and intraoperative evaluation for identification of adjacent, beyond or remote epileptogenic area and the eloquent area. RESULTS: Of these 12 patients, vascular malformations(AVM, cavernous angioma) were 7, overt hemorrhage due to vascular lesion were 2 and intractable ongoing seizure after vascular surgery were 3. Other vascular lesion including occlusive disease, moyamoya disease or previous hemorrhage were excluded in this study. The location of the lesion was mainly temporal and peri-Rolandic areas, and dual pathology was verified in 2 cases of 6 temporal lesion. The surgical outcome(class I;7, II;3, III;1, IV;1) was excellent by Engel's classification. CONCLUSION: Control of seizures related to vascular lesions remains strong indication for surgical resection. For this reason, careful presurgical evaluations are essential to evaluate the remote epileptogenic area, especially in temporal lesion. Intraoperative acute recording(ECoG) and functional mapping by electrical stimulation or SSEP are important for maximal resection of epileptogenic area with minimal sequellae.

Huge Cyst Formation after Gamma Knife Radiosurgery for Arteriovenous Malformation: A Case Report

Radiosurgery is effective in obliterating cerebral arteriovenous malformation(AVM), and delayed cyst formation after radiosurgery is very rare. An 18-year-old man underwent Gamma Knife radiosurgery for arteriovenous malformation located in the left frontotemporal area, which had manifested with hemorrhaging. The 15,01cm3 nidus was covered with a 50% isodose volume. A central dose of 50Gy was used to obtain a marginal dose of 25Gy. One year later, he developed headache and right hemiparesis. MRI showed a huge, multilobulated cyst around the AVM. Follow-up cerebral angiography showed partial obliteration of the AVM nidus. Removal of cystic fluid(about 70cc) was done by stereotactic method, which was revealed as translucent, xanthochromic but had no tumor cell. Two months later, reaccumulation of the cyst was seen on the follow-up MRI insertion setting of Ommaya reservoir was performed. For the diagnosis of complications after radiosurgery for AVM, follow-up study, will be needed.