PMID- 36386341 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20221118 IS - 2297-055X (Print) IS - 2297-055X (Electronic) IS - 2297-055X (Linking) VI - 9 DP - 2022 TI - Management of high-output cardiac failure caused by head and neck AVMs: Percutaneous suture-assisted ethanol and coil embolotherapy. PG - 949558 LID - 10.3389/fcvm.2022.949558 [doi] LID - 949558 AB - PURPOSE: The aim of this study was to describe the treatment technique, outcomes, and complications of Schobinger stage IV head and neck arteriovenous malformations (HNAVMs) with associated high-output cardiac failure (HOCF) using ethanol and coils with the percutaneous suture technique. METHODS: From January 2015 to December 2019, 19 patients who had HNAVMs with associated HOCF were treated first with a percutaneous suture of the remarkably dilated dominant drainage vein (RDDOV) and subsequent embolization with coils and ethanol. The percutaneous suture of RDDOV was preferred to be performed, followed by the deployment of coils and the injection of absolute ethanol via transarterial approach, direct puncture approach, or both of them. Treatment outcomes and complication rates were evaluated at follow-up. RESULTS: A total of 19 patients who experienced HNAVMs with HOCF received 19 percutaneous suture procedures and 84 embolization procedures with ethanol and coils. Complete or >90% shunt reduction of the AVM was achieved in 16 patients. Notably, 19 patients with New York Heart Association (NYHA) stage II improved to stage I, and the symptom of dyspnea disappeared after embolization. The symptoms of five patients with bleeding disappeared. All patients presented with cosmetic concerns; Four were cured, and eight had a clearly recognizable improvement. Of note, 19 (100%) patients presented with impairment of daily life, which was resolved. The minor complications were encountered and recovered by the self. No major complications occurred. CONCLUSION: This study provides evidence that ethanol and coil embolotherapy is effective and safe in treating HOCF caused by HNAVMs with acceptable complications in these cases. The percutaneous suture technique for RDDOV management can act as an adjunct for embolotherapy. CI - Copyright (c) 2022 Wen, Li, Shen, Wang, Zheng, Wang, Fan, Su and Yang. FAU - Wen, Ming-Zhe AU - Wen MZ AD - Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. FAU - Li, Xin-Yu AU - Li XY AD - Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. AD - Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. FAU - Shen, Yu-Chen AU - Shen YC AD - Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. FAU - Wang, Zhen-Feng AU - Wang ZF AD - Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. FAU - Zheng, Lian-Zhou AU - Zheng LZ AD - Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. FAU - Wang, De-Ming AU - Wang DM AD - Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. FAU - Fan, Xin-Dong AU - Fan XD AD - Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. FAU - Su, Li-Xin AU - Su LX AD - Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. FAU - Yang, Xi-Tao AU - Yang XT AD - Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. LA - eng PT - Journal Article DEP - 20221026 PL - Switzerland TA - Front Cardiovasc Med JT - Frontiers in cardiovascular medicine JID - 101653388 PMC - PMC9662295 OTO - NOTNLM OT - arteriovenous malformations OT - coils OT - embolization OT - ethanol OT - high output cardiac failure COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2022/11/18 06:00 MHDA- 2022/11/18 06:01 PMCR- 2022/01/01 CRDT- 2022/11/17 11:42 PHST- 2022/06/21 00:00 [received] PHST- 2022/10/04 00:00 [accepted] PHST- 2022/11/17 11:42 [entrez] PHST- 2022/11/18 06:00 [pubmed] PHST- 2022/11/18 06:01 [medline] PHST- 2022/01/01 00:00 [pmc-release] AID - 10.3389/fcvm.2022.949558 [doi] PST - epublish SO - Front Cardiovasc Med. 2022 Oct 26;9:949558. doi: 10.3389/fcvm.2022.949558. eCollection 2022.