Interventional therapy in arteriovenous congenital malformations

Abstract

Before beginning a session of embolotherapy, all afferent arteries feeding the shunt should be clearly demonstrated. To get optimal documentation, large quantities of contrast media injection may be necessary, as selective and superselective angiographies are required. For this reason, and also because of a multidisciplinary discussion necessary to plan the treatment, embolization is best performed in a second session. Materials available for embolization can be divided into fluid, semi-fluid, particulate substances and mechanical devices. Different types of catheter devices are available, including flow-directed Swan-Ganz and Tracker catheters with coaxial combinations, useful for special situations. The strategy and tactic of the treatment should be adapted to the individual case. A step-by-step approach, combination with surgery and other treatments may reduce the risks of complications. © 2009 Springer-Verlag Milan.