Purpose To assess the effectiveness and safety of the use of transvenous approach in the endovascular surgery of cerebral arteriovenous malformations (AVM) Materials: during the period from 2016 till 2018 in the department of vascular neurosurgery with the use of transvenous approach, 27 patients were operated. Most malformations were located supratentorial (25). On the S and M scale: I – 4 (14.8%), II – 8 (29.6%), III – 12 (44.5%), IV – 3 (11.1%).

Results 29 surgical interventions were performed. For access to the venous system, right-side femoral access was used. Only transvenous embolization, in the absence of arterial access to the AVM nidus 10 (37%) patients, combined, transarterial +transvenous embolizate injection, were performed in 17 (63%) patients. Total occlusion of malformation was noted in all patients. Favorable outcomes of treatment (0–1) according to the modified Rankin scale were obtained in 24 (88.9%) patients. There were no lethal outcomes. A hemorrhagic complication in the form of a subarachnoid hemorrhage occurred in 1 patient. Ischemic complications were also noted in 2 patients with malformations of subcortical structures.

Conclusion The use of transvenous approach in the endovascular surgery of arteriovenous malformations of the brain allows performing interventions on hard-to-reach for traditional transarterial embolization malformations. The high efficiency of the method, first of all, is due to the appropriate selection of patients. Combined approach raises the radical nature of surgical intervention, allowing to exclude residual filling of the malformation compartment.

Disclosures V. Kiselev: 2; C; Microvention, Balt, Medtronic. A. Perfilev: None. A. Sosnov: None. R. Gafurov: None.