embolotherapy of peripheral avms · symptomatic peripheral avm lower limb • 47 years, female •...
TRANSCRIPT
![Page 1: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/1.jpg)
Embolotherapy of peripheral AVMs
Maliha SadickInterdisciplinary Center of Vascular Anomalies
Institute for Clinical Radiology and Nuclear MedicineUniversity Hospital Mannheim/Germany
Technical Forum – Technical and practical aspects of highend embolo therapy
![Page 2: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/2.jpg)
Disclosure
Speaker name:
Maliha Sadick
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interestx
![Page 3: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/3.jpg)
Vascular Anomalies
Tumors Malformations
- Benign:
Infantile Hemangioma (IH)
Rapidly involuting congenital hemangioma (RICH)
Non-involuting congenital hemangioma (NICH)
- Borderline:
Kaposiform Hemangioendothelioma (KHE)
Epithelioid Hemangioendothelioma (EHE)
-Malignant:
Angiosarcoma
- Slow flow:
Capillary malformation (CM)
Venous malformation (VM)
Lymphatic malformation (LM)
- Fast flow:
Arteriovenous malformation (AVM)
Arteriovenous fistula (AVF)
- Combined and Syndromic
![Page 4: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/4.jpg)
Fast Flow Vascular Anomalies
![Page 5: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/5.jpg)
Flow DynamicsImpact on Treatment Decision
• Availabilty of liquid, mechanical,
spherical embolic materials
• Indications to treat: pain, functionalimpairment, ulceration, bleeding, flow related aneurysms, bonedystrophia, venous insufficiency, high output cardiac failure
• Aim: permanent nidus effusion andplugging of the dominant outflowvein
![Page 6: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/6.jpg)
Flow DynamicsImpact on Embolisation Techniques
• Techniques: transarterial, transvenous, percutaneous access or combined• One or more sessions required• Go for nidus and/or DOV embolisation in retrograde push-technique
![Page 7: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/7.jpg)
Flow DynamicsImpact on Embolisation Techniques
The Retrograde Transvenous Push-Through Method: A Novel Treatment of Peripheral AVM´s withDominant Venous Outflow, Cardiovasc Intervent Radiol 2015, W. Wohlgemuth, R. Muller-Wille et al.
![Page 8: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/8.jpg)
Choice of Embolic Liquid Embolisation Agents
• Alcohol 96%, Ethylene Vinyl Alcohol Copolymer (Onyx®) for nidus penetration
• Onyx: Ethylene Vinyl Alcohol Copolymer soluted in Dimethyl-Sulfoxide (DMSO). Fordesired character of the liquid, the concentration can be varied to 6% or 8% EVOH (Onyx 18, Onyx 34). Micronized tantalum powder for radiopacity
• Indications: transarterial nidus embolisation, direct percutaneous access to nidusand/or DOV, transvenous retrograde push-through technique for nidus and DOV embolisation
![Page 9: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/9.jpg)
Case ISymptomatic Peripheral AVM Lower Limb
• 47 years, female• Pulsating tumor in right calf with increase in size• Pain, leg swelling• Recurrent ulceration and bleeding episodes• Purpura jaune d´ocre• Increasing immobilization in daily life
![Page 10: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/10.jpg)
Case I
![Page 11: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/11.jpg)
Case I
![Page 12: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/12.jpg)
Case IISymptomatic Pelvine AVM
38 years oldFemaleAbdominal painCardiac symptomsRight heart insufficiency
![Page 13: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/13.jpg)
Case II
![Page 14: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/14.jpg)
Case II
![Page 15: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/15.jpg)
Case II
![Page 16: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/16.jpg)
![Page 17: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/17.jpg)
Case II
![Page 18: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/18.jpg)
Take Home Points• Diagnosis
• Assessment of AVM Characteristics
• Interdisciplinary Consult
• Interventional Radiology Procedure Plan
• Risk-benefit Stratification
• Technical and Therapeutic Equipment
• Consideration of Reimbursement Issues
• Peri- and Postinterventional Case & Care Management
![Page 19: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/19.jpg)
Thank you for your [email protected]
![Page 20: Embolotherapy of peripheral AVMs · Symptomatic Peripheral AVM Lower Limb • 47 years, female • Pulsating tumor in right calf with increase in size • Pain, leg swelling • Recurrent](https://reader034.vdocuments.us/reader034/viewer/2022051908/5ffc01aaaf115a7eae549b1a/html5/thumbnails/20.jpg)
Embolotherapy of peripheral AVMs
Maliha SadickInterdisciplinary Center of Vascular Anomalies
Institute for Clinical Radiology and Nuclear MedicineUniversity Hospital Mannheim/Germany
Technical Forum – Technical and practical aspects of highend embolo therapy