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E-226 Endovascular treatment of pediatric arteriovenous shunts
  1. V Berestov1,2,
  2. K Orlov1,2,
  3. N Strelnikov1,
  4. A Brusyanskaya1,
  5. A Somova1
  1. 1Endovascular Neurosurgery Department, Federal Center of Brain Research and Neurotechnologies, Moscow, Russian Federation
  2. 2Oncology and Neurosurgery Center, Academician E.N.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation


Background Pediatric arteriovenous malformations (AVM) and pial/dural arteriovenous fistulas (AVF) are rare but life-threatening diseases that can lead to congestive heart failure and hemorrhagic stroke in newborns and pediatric patients. The pronounced shunting in these conditions is associated with early complications and necessitates aggressive surgical management.

Materials and Methods For 10 years, our team at the Meshalkin National Medical Research Center and Federal Center of Brain Research and Neurotechnologies has accumulated extensive experience in endovascular treatment of pediatric patients with congenital cerebrovascular pathology; we have conducted a total of 158 procedures in 70 patients, including 18 endovascular interventions in 16 newborns. Overall complication rate was 14,3% (10 pts) with 10,0% (7 pts) morbidity rate. Total cure was achieved in 41 patients (58,6%).

Results Based on our experience of using various embolic agents, we believe that cyanoacrylate compositions are the most suitable for AVF embolization. Due to their adhesive properties, they allow for controlled and effective occlusion of high-flow fistulas (more than 70% of procedures in our series of cases). Non-adhesive compositions are effective for final embolization of residual small feeders (28,5%).In one case (AVF formed direct communication between basilar artery and dilated deep cerebral vein) we have performed subtotal embolization of the AVF by 0,020’’ coils, which led to progressive thrombosis of the fistula with restoration of normal arterial blood flow. The patient was discharged 18 days after surgery, and MRI at 1.5 and 6 months showed the absence of blood flow through the fistula and satisfactory condition of the infant without physical and mental developmental delay.

Abstract E-226 Figure 1

Anteroposterior (A, C) and lateral (B, D) vertebral angiograms before (A, B) and after (C, D) AVF embolization in the same phase of contrast enhancement. A significant improvement in contrast enhancement of cerebral vessels and a pronounced decrease in blood flow through the fistula are observed

Conclusion Endovascular treatment of pediatric arteriovenous shunts is extremely difficult and associated with high risks of complications. However, excellent clinical results can be achieved in specialized clinics. The choice of embolic agent should depend on the hemodynamic load of the pathological blood flow.

Disclosures V. Berestov: None. K. Orlov: None. N. Strelnikov: None. A. Brusyanskaya: None. A. Somova: None.

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