TY - JOUR
T1 - Evolution of transvenous embolization in vein of Galen malformation
T2 - Case series and review of the literature
AU - Fifi, Johanna T.
AU - Bazil, Maximilian Jeremy
AU - Matsoukas, Stavros
AU - Shigematsu, Tomoyoshi
AU - Sorscher, Michelle
AU - Berenstein, Alejandro
N1 - Publisher Copyright:
© 2023 Authors. All rights reserved.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Background Treatment of vein of Galen malformations (VOGMs) has improved greatly since the inception of endovascular treatment. Transvenous embolization (TVE) is an attractive option to achieve complete obliteration. Objective To review the literature on TVE of VOGM and then analyze our practice's unique experience and evolving treatment strategies over 30 years. Methods A retrospective review of our clinical database for patients with the diagnosis of VOGM treated between January 2004 and August 2021 was performed. A literature review of 49 relevant articles was also carried out. Results TVE in VOGM has evolved with initial introduction as a transtorcular (TT) approach, which then lost favor to transarterial embolization (TAE). TAE has been considered the more favorable approach in most high-volume centers. In more recent times, the transvenous embolization (TVE) approach has been revisited as a last treatment to achieve a cure after a series of TAE treatments. We presently favor beginning treatment with staged TAE to reduce flow to the lesion and, importantly, shrink the draining vein. This then allows for the performance of TVE with the Chapot pressure cooker technique (CPCT) with coils and liquid embolic embolization. Conclusions TT TVE itself carries a high degree of risk and is most highly associated with long-term morbidities and mortality. Traditional transfemoral/transjugular TVE approaches are safe and effective in simple fistulas with a small venous pouch; however, we believe that the CPCT is the safest technique as a last-stage treatment for its security in avoiding reflux and obtaining occlusion of the small perforators.
AB - Background Treatment of vein of Galen malformations (VOGMs) has improved greatly since the inception of endovascular treatment. Transvenous embolization (TVE) is an attractive option to achieve complete obliteration. Objective To review the literature on TVE of VOGM and then analyze our practice's unique experience and evolving treatment strategies over 30 years. Methods A retrospective review of our clinical database for patients with the diagnosis of VOGM treated between January 2004 and August 2021 was performed. A literature review of 49 relevant articles was also carried out. Results TVE in VOGM has evolved with initial introduction as a transtorcular (TT) approach, which then lost favor to transarterial embolization (TAE). TAE has been considered the more favorable approach in most high-volume centers. In more recent times, the transvenous embolization (TVE) approach has been revisited as a last treatment to achieve a cure after a series of TAE treatments. We presently favor beginning treatment with staged TAE to reduce flow to the lesion and, importantly, shrink the draining vein. This then allows for the performance of TVE with the Chapot pressure cooker technique (CPCT) with coils and liquid embolic embolization. Conclusions TT TVE itself carries a high degree of risk and is most highly associated with long-term morbidities and mortality. Traditional transfemoral/transjugular TVE approaches are safe and effective in simple fistulas with a small venous pouch; however, we believe that the CPCT is the safest technique as a last-stage treatment for its security in avoiding reflux and obtaining occlusion of the small perforators.
KW - Arteriovenous Malformation
KW - Malformation
KW - Pediatrics
KW - Technique
KW - Vascular Malformation
UR - http://www.scopus.com/inward/record.url?scp=85134521692&partnerID=8YFLogxK
U2 - 10.1136/jnis-2022-019121
DO - 10.1136/jnis-2022-019121
M3 - Article
C2 - 35835461
AN - SCOPUS:85134521692
SN - 1759-8478
VL - 15
SP - 579
EP - 583
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
IS - 6
ER -