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Transvenous embolization of a ruptured cerebral arteriovenous malformation with en-passage arterial supply: initial case report
  1. Thanh N Nguyen1,2,3,
  2. Lawrence S Chin2,
  3. Rosemary Souza3,
  4. Alexander M Norbash3
  1. 1Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2Department of Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
  3. 3Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Dr T Nguyen, Departments of Neurology, Neurosurgery and Radiology, Boston Medical Center, Boston University School of Medicine, 720 Harrison Avenue, Suite 707, Boston, MA 02118, USA; thanh.nguyen{at}bmc.org

Abstract

A patient with a ruptured left sylvian fissure arteriovenous malformation (AVM) treated with primary transvenous Onyx embolization, and angiographically cured, is reported. The patient presented with a large intraparenchymal subopercular hematoma and there was angiographic demonstration of a pseudoaneurysm and single draining vein. Trans-arterial approaches were unsuccessful because of the en-passage nature of feeding arteries and hence a transvenous approach was used to embolize the pseudoaneurysm with Onyx. Follow-up angiography at 1 month revealed durable angiographic cure of the AVM. Our case illustrates that in patients with ruptured AVM secondary to pseudoaneurysm and single draining vein, transvenous treatment can be utilized to achieve occlusion of the pseudoaneurysm resulting in AVM cure. To our knowledge, this is the first description of a transvenous approach for endovascular therapy of AVM.

  • Vein
  • Hemorrhage
  • Angiography
  • Intervention
  • Technique
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Footnotes

  • Please note the content of this manuscript has been altered to protect the identity of the patient.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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