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Original research
Experimental investigation of transvenous embolization of arteriovenous malformations using different in vivo models
  1. Dominik F Vollherbst1,
  2. Matthias Hantz1,
  3. Niclas Schmitt1,
  4. Thuy D Do2,
  5. Ulf Neuberger1,
  6. Hans U Kauczor2,
  7. Martin Bendszus1,
  8. Christof M Sommer3,4,
  9. Markus A Möhlenbruch1
  1. 1Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
  2. 2Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
  3. 3Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
  4. 4Clinic for Radiology and Neuroradiology, Sana Kliniken Duisburg, Duisburg, Germany
  1. Correspondence to Dr Dominik F Vollherbst, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany; dominik.vollherbst{at}


Background Transvenous embolization (TVE) is an emerging technique for the endovascular treatment of cerebral arteriovenous malformations (AVMs). The aim of this study was to investigate two in vivo AVM models and to assess TVE techniques using these models.

Methods Blood flow in the porcine rete mirabile (RM) was modified by either creating a carotid–jugular fistula or by placing a balloon guide catheter in the carotid artery. The RM was embolized with precipitating hydrophobic injectable liquid (PHIL) 25% via transarterial embolization (TAE; control group) and compared with TVE applying the transvenous retrograde pressure cooker technique and TVE using a Woven EndoBridge (WEB) device for flow control (n=6, respectively). The embolization extent (penetration of the RM), the number of events of reflux or embolization distal to the RM and the procedure times were assessed.

Results The modified RM could be successfully used for embolization in all cases. There were no significant differences regarding the outcome parameters between the two AVM models (fistula or balloon). TVE using the pressure cooker technique led to a higher extent of embolization (median 98.8% vs 63.5%; p=0.008), a lower number of reflux or distal embolization events (p<0.001) and a shorter procedure time (p<0.001) compared with conventional TAE. TVE using a WEB device for flow control was technically feasible and achieved a moderate extent of embolization (median 83.8%).

Conclusion After surgical or endovascular modification, the porcine RM is a feasible in vivo AVM model for the investigation of TVE techniques. TVE using the pressure cooker technique is superior to conventional TAE in this experimental model.

  • Arteriovenous Malformation
  • Intervention
  • Liquid Embolic Material
  • Technique

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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  • Contributors DFV and MAM acquired, analyzed, and interpreted the data for the work, designed the study, drafted the manuscript and approved the final manuscript. DFV and MAM are guarantors of this work. MH, NS, TDD, UN, HUK, CMS and MB acquired and analyzed data for the work and approved the final manuscript.

  • Funding This work was technically and financially supported by MicroVention (Aliso Viejo, California, USA) without any impact on data acquisition, analysis, and interpretation.

  • Competing interests DFV has received travel support outside this work from MicroVention and Stryker GmbH & Co. KG. MB reports board membership: DSMB Vascular Dynamics; consultancy: Roche, Guerbet, Codman; grants/grants pending: DFG, Hopp Foundation, Novartis, Siemens, Guerbet, Stryker, Covidien; payment for lectures (including service on speakers' bureaus): Novartis, Roche, Guerbet, Teva, Bayer, Codman. MAM has received consulting honoraria, speaker honoraria, and travel support outside this work from Codman, Covidien/Medtronic, MicroVention, Phenox, and Stryker.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.