Endovascular Management of High-Flow Vascular Malformation

Objective: To provide a review on the endovascular management of high-flow vascular malformations (AVM). Review: AVMs are challenging lesions to treat for the interventional radiologist. The authors describe the pre-procedural evaluation as well specific techniques used for embolization. Peripheral high-flow AVMs may present as a mass with or without a palpable bruit. In the extremities, AVMs can lead to ischemic symptoms. Other manifestations include high-flow states, growth disturbances, and bleeding. Embolization is the mainstay of treatment of AVMs. Surgery is reserved for lesions that are completely resectable or for lesions needing immediate symptomatic control. The goal of embolization is to eradicate the nidus, which can serve to recruit collaterals if not fully embolized. Several embolic agents can be used, such as particles, coils, and liquid embolics (onyx and glue). Triaxial access is often used to access the AVMs, and embolic agents are injected using a combination of di more...