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E-227 The retrograde vein approach as a curative treatment strategy for yakes type I, IIb AVMs, IIIa AVMs, And IIIb AVMs
  1. W Yakes
  1. Vascular Malformation Center, Englewood, CO, USA


Purpose To evaluate the role of Retrograde Vein and Direct Puncture Retrograde Vein Endovascular Repair of Large Peripheral AVMs.

Material and Methods 87 patients (45 males, 42 females; age: 14 - 72, mean age: 27 years) presented for repair of AVMs involving head and neck, shoulder, chest wall, intra-thoracic, abdominal, renal, pelvic, buttock, and extremities. Ethanol and ethanol/coils were the embolic agents used. Retrograde transvenous catheterizations and vein direct puncture retrograde vein approaches were used in all patients.

Results 85 of 87 patients are cured at long-term follow-up (f/up: 14 months to 138 months; mean: 42 months) and 2 patients’ therapy is on-going. Complications include 1 pelvic AVM post-Rx small bleed not requiring transfusion; 1 pelvic AVM coils eroded into bladder wall removed uneventfully via trans-urethra endoscopy; 2 infections treated with antibiotics; 2 patients’ coils superficially eroded and uneventfully removed; and 1 patient subcutaneous hematoma removed (7/87 patients; 8% minor complications).

Conclusions Retrograde vein and direct puncture vein access and embolization of AVMs in many anatomic locations have proven curative at long-term f/up of AVMs in multiple anatomic locations with a low complication rate. Reproducible and consistent results of this technique have been reported only in 4 publications in the world’s literature: by Yakes (1990), Gomes (1994), Jackson (1996) and Cho (2008). In the Yakes AVM Classification System, these approaches can routinely effect AVM cures in Yakes Types I, IIa, IIIa, and IIIb.

Disclosures W. Yakes: None.

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