MATERIALS AND METHODS OF ARTERIOVENOUS MALFORMATIONS’ ENDOVASCULAR TREATMENT: OPPORTUNITIES AND PROBLEMS

Issue: 
7
Year: 
2016

V.N. Dan
Dr.Sc. (Med.), Institute of Surgery named after A.V. Vishnevsky (Moscow)
E-mail: ospolimed@mail.ru
S.V. Sapelkin
Ph.D. (Med.), Institute of Surgery named after A.V. Vishnevsky (Moscow)
O.A. Legonkova
Dr.Sc. (Eng.), Institute of Surgery named after A.V. Vishnevsky (Moscow)
V.N. Tsygankov
Ph.D. (Med.), Institute of Surgery named after A.V. Vishnevsky (Moscow);
I.M. Sechenov First Moscow State Medical University
A.B. Varava
Ph.D. (Med.), Institute of Surgery named after A.V. Vishnevsky (Moscow)
S.A. Kedik
Dr.Sc. (Chem.), Lomonosov Moscow State University of Fine Chemical Technologies;
Closed Joint Stock Company «Institute of Pharmaceutical Technology» (Moscow)
E.S. Zhavoronok
Ph.D. (Chem.), Lomonosov Moscow State University of Fine Chemical Technologies;
Closed Joint Stock Company «Institute of Pharmaceutical Technology» (Moscow) A.V. Panov
Ph.D. (Chem.), Lomonosov Moscow State University of Fine Chemical Technologies;
Closed Joint Stock Company «Institute of Pharmaceutical Technology» (Moscow)

The article is devoted to the comparison of different embolic agents for treatment of arteriovenous malformations. Advantages and disadvantages of each type, application features, depending on the location of lesion are shown. Endovascular treatment with the use of different types of embolization or sclerotherapy is now recognized as the most preferred «therapeutic option» in the treatment of most non-stem arteriovenous malformations (congenital malformations of the circulatory system) AVM. Endovascular occlusion and / or sclerotherapy in self-holding can be considered as method of choice in lesions where surgery can’t be performed for some or other reasons, or it involves a very high risk of injury. Such cases are malformation located deep beneath the fascia, extensive damage of muscles, bony structures, i.e diffuse infiltrative type of non-stem forms of AVM. It should be reminded that in order to achieve adequate results, embolic substance (emboli, adhesive particles) or sclerosant must be injected directly into the zone of direct bypass («central focus» / nidus). For maximum impact on the area of arteriovenous shunting it is necessary to use potentials of all three approaches - transarterial, transvenous or direct transdermal puncture of nidus. Generally, treatment becomes multi-session; during each session, one must make every effort to minimize the risk of possible complications. In this respect the choice of the type of embolic agent is decisive in many ways. So, the problem of the maximum closing of arteriovenous reset zones using embolization agents is not completely solved. Embolic agent must be chosen depending on specific case. The choice must be based on the localization of the damage, its morphology and clinical picture. Each type of embolic agents (solid, liquid or spiral) has its own advantages and disadvantages. That’s why the search of an ideal embolic agent using achievements of modern chemistry and techniques is still remaining actual.

Keywords: 
Key words: arteriovenous malformation (AVM)
endovascular occlusion
embolisation
emboli.