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Jia H, Chen Y, Yang X, Lee Y, Zou Y, Zhou J, Jin Y, Hua C, Lin X. Treatment of Challenging Extracranial Arteriovenous Malformations: A Single-Center Experience and Literature Review. Ann Plast Surg 2023; 90:S177-S182. [PMID: 36752531 DOI: 10.1097/sap.0000000000003375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ABSTRACT Extracranial arteriovenous malformation (AVM) is a high-flow congenital vascular malformation, where direct communication between the arteries and veins impedes perfusion of capillary beds and causes disfigurement of the affected tissue. Surgery and endovascular therapy are currently the main treatment for extracranial AVMs. Nevertheless, management of complex cases is sometimes challenging because of severe complications such as refractory ulceration, life-threatening bleeding, and even cardiac insufficiency. Here, we reviewed the development and potential treatment for extracranial AVMs and shared our single-center experiences of diagnosis and treatment of this challenging disease.
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Affiliation(s)
- Hechen Jia
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Tannai H, Oguro S, Nagao M, Ota H, Takase K. High-flow arteriovenous malformation in the finger with transvenous ethanolamine oleate sclerotherapy using an arterial tourniquet and microballoon occlusion: A case report. Radiol Case Rep 2023; 18:1973-1977. [PMID: 36970241 PMCID: PMC10036881 DOI: 10.1016/j.radcr.2023.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/22/2023] Open
Abstract
Endovascular therapy is an important method of treating high-flow arteriovenous malformations (AVMs). The nidus of AVMs can be treated by transarterial or percutaneous approaches with the use of ethanol as a strong embolic agent; however, treatment outcomes are not always satisfactory and complications including skin necrosis often occur, particularly following the treatment of superficial lesions. Herein, we describe successful transvenous sclerotherapy of high-flow AVMs in the finger of a 47-year-old female patient that were causing erythema and spontaneous pain using ethanolamine oleate (EO) as a safe sclerosant. Dynamic contrast-enhanced computed tomography and angiography revealed a high-flow type Ⅲb AVM according to Yakes classification. Using the transvenous approach, 5% EO with idoxanol was injected into the nidus of the AVM 3 times over 2 sessions. An arterial tourniquet was used to achieve stasis of blood flow at the nidus and microballoon occlusion of the outflow vein was used to ensure the sclerosant effectively reached the nidus. Near-total occlusion of the nidus was achieved leading to improved symptoms. Mild edema lasting 2 weeks occurred as a minor reaction after each session. Finger amputation may have been avoided by using this treatment. Transvenous EO sclerotherapy using an arterial tourniquet and balloon occlusion may have utility in treating AVMs in the extremities.
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Affiliation(s)
- Hiromitsu Tannai
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 2...1 Seiryo...machi, Aoba...ku, Sendai, Miyagi, 980-8575, Japan
| | - Sota Oguro
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 2...1 Seiryo...machi, Aoba...ku, Sendai, Miyagi, 980-8575, Japan
- Corresponding author.
| | - Munetomo Nagao
- Department of Plastic and Reconstructive Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 2...1 Seiryo...machi, Aoba...ku, Sendai, Miyagi, 980-8575, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 2...1 Seiryo...machi, Aoba...ku, Sendai, Miyagi, 980-8575, Japan
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Lilje D, Wiesmann M, Hasan D, Ridwan H, Hölzle F, Nikoubashman O. Interventional embolization combined with surgical resection for treatment of extracranial AVM of the head and neck: A monocentric retrospective analysis. PLoS One 2022; 17:e0273018. [PMID: 36048777 PMCID: PMC9436082 DOI: 10.1371/journal.pone.0273018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/29/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The aim of this study was to demonstrate the efficacy and feasibility of treating patients with extracranial arteriovenous malformations (AVM) of the head and neck with interventional embolization followed by surgical resection. Methods We reviewed the charts of all patients between 2012 and 2021 with extracranial AVM of the head and neck scheduled for interdisciplinary treatment according to University Hospital RWTH Aachen’s protocol and conducted standardized interviews using a newly developed questionnaire. Interview results, as well as clinical examination and radiographic outcome results were analyzed to help determine the efficacy of our treatment approach. Results We included 10 patients (8 female, 2 male), with a mean age of 33.5 (11–61) years who were scheduled for treatment of the AVM with interventional embolization followed by surgical resection. In 6 of the 10 patients (60%) the lesion was located in extracranial soft tissue only. In one patient (10%), the lesion was located in bone tissue only. A combined intraosseous and oral soft tissue lesion was seen in the remaining 3 patients (30%). Radiographic resolution was achieved in 62.5% of cases and a significant decrease of symptoms was identified (p = 0.002). None of the patients reported dissatisfaction and no major complications occurred. Conclusion An interdisciplinary treatment approach combining neuroradiological interventions with surgical resection appears to be an effective treatment with an acceptable complication rate. Patients treated according to our protocol showed a high satisfaction rate, regardless of the radiographic outcome. Standardized follow-up allows for early detection of recurrences and helps with subjective patient satisfaction.
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Affiliation(s)
- Daniel Lilje
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Dimah Hasan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Hani Ridwan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
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Onishi M, Onishi Y, Yasumura S, Nakai H, Hamasaki M, Miyake M, Taniguchi T. Chest wall systemic artery-to-pulmonary artery vascular malformation treated by embolization of feeders and drainers: A case report. Radiol Case Rep 2022; 17:3395-3398. [PMID: 35880239 PMCID: PMC9307446 DOI: 10.1016/j.radcr.2022.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/25/2022] [Indexed: 11/17/2022] Open
Abstract
A 74-year-old woman presented with progressive dyspnea. Computed tomography revealed a large systemic artery-to-pulmonary artery vascular malformation (VM) on the right chest wall. Embolization of the VM was performed. First, the main drainers of the VM were retrogradely selected from the segmental pulmonary arteries and embolized using microcoils. Second, 2 main feeders of the VM were selected and embolized with N-butyl cyanoacrylate. Thus, marked flow reduction in the VM was achieved, and the patient's symptom improved dramatically. We believe that embolization of both feeders and drainers is an effective technique for treatment of a chest wall systemic artery-to-pulmonary artery VM.
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Affiliation(s)
- Motofumi Onishi
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
- Corresponding author.
| | - Yasuyuki Onishi
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
| | - Sumika Yasumura
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
| | - Hirotsugu Nakai
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
| | - Maki Hamasaki
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Takanori Taniguchi
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
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Lilje D, Wiesmann M, Hasan D, Riabikin A, Ridwan H, Hölzle F, Nikoubashman O. Interventional therapy of extracranial arteriovenous malformations of the head and neck—A systematic review. PLoS One 2022; 17:e0268809. [PMID: 35839171 PMCID: PMC9286278 DOI: 10.1371/journal.pone.0268809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/06/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The primary aim of this study was to conduct a meta-analysis of the literature on interventional treatment for patients with extracranial AVM of the head and neck to identify a superior treatment. The secondary aim was to evaluate the methodological quality of associated articles published between 2000–2020. Methods The literature search was conducted on PubMed, Embase, the Cochrane Library, and scholar.google.com. Studies, meeting the acceptable reference standard underwent meta-analysis. All identified literature underwent methodological quality analysis. Results Of 1560 screened articles, 56 were included in the literature review. Appropriate diagnostic tests were reported in 98% of included articles. 13% of included articles did not specify the embolization agent. Outcome analysis varied throughout. 45% of the authors used radiographic imaging for follow-up. 77% specified the span of follow-up of their entire patient collective. Two articles met the inclusion criteria for meta-analysis. Curing rate of transarterial ethanol embolization for intraosseous AVM was 83% with a complication rate of 58%. Curing rate of ethanol combined with NBCA or Onyx in soft tissue AVM was 18% with a complication rate of 87%. Conclusion Our literature review revealed an absence of treatment or reporting standards for extracranial AVM of the head and neck. The meta-analysis is comprised of two articles and methodological quality is heterogeneous. We recommend implementing consistent reporting standards to facilitate comparability of studies and to provide robust data for the development of an evidence-based treatment strategy. Advances in knowledge Meta-analysis showed a favorable radiological outcome for intraosseous AVM when treated with intraarterial ethanol embolization. Our analysis demonstrated that the published data on extracranial AVMs of the head and neck is lacking in consistency and quality, prompting agreement for the need of standardized reporting on AVM treatments.
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Affiliation(s)
- Daniel Lilje
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Dimah Hasan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Alexander Riabikin
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Hani Ridwan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hölzle
- Department of Oral, Maxillofacial and Facial Plastic Surgery University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
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Soulez G, Gilbert, MD, FRCPC P, Giroux, MD, FRCPC MF, Racicot, MD, FRCPC JN, Dubois J. Interventional Management of Arteriovenous Malformations. Tech Vasc Interv Radiol 2019; 22:100633. [DOI: 10.1016/j.tvir.2019.100633] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kitagawa A, Yamamoto T, Matsunaga N, Yamaji M, Ikeda S, Izumi Y, Hagihara M, Ota T, Ishiguchi T. Polidocanol Sclerotherapy Combined with Transarterial Embolization Using n-Butyl Cyanoacrylate for Extracranial Arteriovenous Malformations. Cardiovasc Intervent Radiol 2018; 41:856-866. [PMID: 29417264 PMCID: PMC5937878 DOI: 10.1007/s00270-017-1855-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022]
Abstract
Purpose To assess the safety and effectiveness of polidocanol sclerotherapy combined with transarterial embolization using a liquid adhesive agent (n-butyl cyanoacrylate, NBCA) for treatment of extracranial arteriovenous malformations (AVMs). Materials and Methods Twenty-three patients with symptomatic AVMs in the head and neck (6), upper (7) and lower extremity (10) with a mean age of 42 years (range 4–74) treated with polidocanol sclerotherapy were retrospectively assessed. AVMs were classified according to the angiographic morphology of the nidus. There were 2 type I, 6 type II, 6 type IIIa and 9 type IIIb. Arterial embolization using NBCA was performed to reduce arterial flow before sclerotherapy. Polidocanol mixed with contrast material or carbon dioxide was delivered by percutaneous direct puncture. Results Treatment was successfully performed in all patients. In the mean follow-up period of 38 months, symptoms resolved or improved in 20/23 patients (87.0%). AVMs were devascularized 100% in 2 patients, 76–99% in 13, 50–75% in 7 and < 50% in 1. More than 50% devascularization was seen in 22 patients (95.6%). Two (8%) patients had complete remission, 17 (74%) had partial remission and 3 (13%) had no remission. There was no aggravation. Treatment was considered effective (complete and partial remission) in 20 patients (87.0%). Minor complications including localized arterial thrombosis (2) and spontaneously healing skin ulcer (1) were seen in 2 patients (8.7%). There were no major procedure-related complications. Conclusion Polidocanol sclerotherapy combined with transarterial embolization using NBCA is safe and effective for treating extracranial AVMs with an acceptable risk of minor complications.
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Affiliation(s)
- Akira Kitagawa
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan.
| | - Takahiro Yamamoto
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Nozomu Matsunaga
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Mayako Yamaji
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Shuji Ikeda
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Yuichiro Izumi
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Makiyo Hagihara
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Toyohiro Ota
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
| | - Tsuneo Ishiguchi
- Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan
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Gilbert P, Dubois J, Giroux MF, Soulez G. New Treatment Approaches to Arteriovenous Malformations. Semin Intervent Radiol 2017; 34:258-271. [PMID: 28955115 DOI: 10.1055/s-0037-1604299] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Arteriovenous malformations (AVMs) are high-flow vascular anomalies that have demonstrated a very high recurrence rate after endovascular treatment, surgical treatment, or a combination of both. Surgical treatments have shown good response when they are small and well localized but a poor response when diffuse. A better understanding of the nature of the lesion has led to a better response rate and a safer treatment for these patients. This has been accomplished through a detailed understanding of the angioarchitecture of the lesion, enabling a tailored approach in reaching and targeting the nidus of the AVM with different liquid embolic agents, more specifically ethanol. Flow reduction techniques help in exposing the nidus to sclerosant agents. A clinical classification, the Schobinger classification, will help determine the appropriate time to start or to pursue therapy.
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Affiliation(s)
- Patrick Gilbert
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Josée Dubois
- Department of Radiology, Centre Hospitalier Universitaire Ste Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie France Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
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Woodhams R, Ogasawara G, Ishida K, Fujii K, Yamane T, Nishimaki H, Matsunaga K, Inoue Y. Successful treatment of acquired uterine arterial venous malformation using N-butyl-2-cyanoacrylate under balloon occlusion. Acta Radiol Short Rep 2014; 3:2047981614545910. [PMID: 25346850 PMCID: PMC4207280 DOI: 10.1177/2047981614545910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/11/2014] [Indexed: 11/30/2022] Open
Abstract
We present two cases of acquired uterine arterial venous malformation (AVM) which was diagnosed because of massive genital bleeding successfully treated with transcatheter arterial embolization (TAE), using N-butyl-2-cyanoacrylate (NBCA) under balloon occlusion. Balloon occlusion at the uterine artery was performed in both patients for diffuse distribution of NBCA in multiple feeding branches, as well as to the pseudoaneurysm, and for the prevention of NBCA reflux. In one of our patients, balloon occlusion of the draining vein was simultaneously performed to prevent NBCA migration through accompanying high-flow arteriovenous fistula (AVF). Doppler ultrasound at 6 months of both patients documented persistent complete occlusion of AVM. Complete and safe obliteration of acquired uterine AVM was accomplished using NBCA as embolic agent, under balloon occlusion at the communicating vessels of acquired uterine AVM.
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Affiliation(s)
- Reiko Woodhams
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Go Ogasawara
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kenichiro Ishida
- Department of Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Japan
| | - Kaoru Fujii
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takuro Yamane
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Keiji Matsunaga
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Kanagawa, Japan
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Tatsuta T, Endo T, Watanabe K, Hasui K, Sawada N, Igarashi G, Mikami K, Shibutani K, Tsushima F, Takai Y, Fukuda S. A successful case of transcatheter arterial embolization with n-butyl-2-cyanoacrylate for pancreatic arteriovenous malformation. Intern Med 2014; 53:2683-7. [PMID: 25447650 DOI: 10.2169/internalmedicine.53.3327] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A 57-year-old man was referred and admitted to our hospital for treatment of a symptomatic pancreatic mass. Pancreatic arteriovenous malformation (AVM) was diagnosed based on the findings of contrast-enhanced computed tomography (CT) and angiography, and transcatheter arterial embolization (TAE) with N-butyl-2-cyanoacrylate (NBCA) was performed without complications. The patient's symptoms subsequently improved after TAE, and resolution of the pancreatic AVM was detected on contrast-enhanced CT performed six months after the embolization procedure. This case indicates that TAE with NBCA is a safe and effective treatment for pancreatic AVM.
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Affiliation(s)
- Tetsuya Tatsuta
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
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