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Is malignant edema and hemorrhage after occlusion of high-flow arteriovenous malformation related to the size of feeding arteries and draining veins?

Tijdschriftbijdrage - Tijdschriftartikel

Objective. - Our study aimed to identify predictive factors for malignant post-treatment edema and hem-orrhage in patients who underwent microsurgical treatment of arteriovenous malformation (AVM) in our institution.Methods. - The study included 72 patients treated by microsurgery for cerebral symptomatic and/or ruptured AVM between 2010 and 2020. Six patients developed postprocedural malignant edema and hemorrhage (group M); the other 66 patients had no malignant edema and hemorrhage (group NM). In each patient, flow was assessed indirectly by summing the diameters of all feeding arteries to obtain an overall diameter (ODA), and similarly for draining veins (ODV). High-flow was defined as a delay between feeding artery injection and draining vein injection (DAV) < 1 second on dynamic digital subtraction angiography. Univariate analysis was performed. Results. - Mean ODA and ODV were respectively 11 mm (+/- 8.2) and 11 mm (+/- 5.3) in group M and 2.9 mm (+/- 1.4) and 3.7 mm (+/- 1.3) in group NM (P = 0.001). High-flow AVM was demonstrated in 4 out of 5 patients (85%) in group M and in 14 out of 55 (25%) in group NM (P = 0.02). Associated aneurysm was seen in 5 patients in group M (83%) and in 11 in group NM (17%) (P = 0.001).Conclusion. - High-flow AVM may be associated with higher risk of postoperative edema and hemorrhage. Multidisciplinary discussion is mandatory in these cases, to define a pre-therapeutic plan for progressive staged vascular malformation occlusion.(c) 2022 Elsevier Masson SAS. All rights reserved.
Tijdschrift: Neuro-chirurgie
ISSN: 0028-3770
Volume: 68
Pagina's: E1 - E7
Jaar van publicatie:2022
Trefwoorden:A1 Journal article