Transarterial embolisation for congenital renal arteriovenous malformations improves clinical condition even with partial obliteration

Transarterial Embolization of Renal Arteriovenous Malformations: Treatment Outcomes According to Angiographic Classification

PURPOSE

To assess the different adjunctive catheter techniques required to achieve complete occlusion of renal arteriovenous malformations (rAVMs) of different angioarchitectural types.

MATERIALS AND METHODS

Overall, data on 18 patients with rAVM (Type 1, n = 7; Type 2, n = 2; Type 3, n = 9; mean age, 53.8 years) who underwent 25 procedures between 2011 and 2022 were reviewed. The clinical presentations, endovascular techniques, arteriovenous malformation (AVM) occlusion rate, adverse events (including the incidence of renal infarction), and clinical symptoms and outcomes (including recurrence/increase of AVM) were analyzed according to the Cho-Do angioarchitectural classification. Posttreatment renal infarction was classified as no infarction, small infarction (<12.5%), medium infarction (12.5%-25%), and large infarction (>25%) using contrast-enhanced computed tomography or magnetic resonance imaging.

RESULTS

Hematuria and heart failure were presenting symptoms in 10 and 2 patients, respectively. The embolic materials used were as follows: Type 1 rAVM, coils alone or with n-butyl-2-cyanoacrylate (nBCA); Type 2 rAVM, nBCA alone or with coils; and Type 3 rAVMs, nBCA alone. Fourteen patients underwent adjunctive catheter techniques, including flow control with a balloon catheter and multiple microcatheter placement, alone or in combination. Immediate postprocedural angiography revealed complete occlusion in 15 patients (83%) and marked regression of rAVM in 3 (17%). Small asymptomatic renal infarctions were observed in 6 patients with Type 3 rAVMs without any decrease in renal function. No major adverse events were observed. All symptomatic patients experienced symptom resolution. Recurrence/increase of rAVM was not observed during the mean 32-month follow-up period (range, 2-120 months).

CONCLUSIONS

Transarterial embolization using adjunctive catheter techniques according to angioarchitectural types can be an effective treatment for rAVMs.

Triple-balloon-assisted n-butyl-2-cyanoacrylate embolization of a cirsoid renal arteriovenous malformation

We report a patient with a cirsoid renal arteriovenous malformation (AVM) causing massive hematuria that was successfully embolized by n-butyl-2-cyanoacrylate under triple-balloon occlusion. Proximal balloons were placed in the renal artery and vein for flow control, and a coaxial microballoon was placed in a feeding artery of the AVM to control the delivery of n-butyl-2-cyanoacrylate. Under triple-balloon occlusion, n-butyl-2-cyanoacrylate embolization achieved complete occlusion of the AVM with no procedure-related complications, such as renal infarction. This triple-balloon-assisted technique enabled us to control blood flow and the delivery of n-butyl-2-cyanoacrylate, allowing complete occlusion of the AVM. This approach may prevent proximal embolization and distal migration of n-butyl-2-cyanoacrylate.