Management of hemorrhagic complications from preoperative embolization of arteriovenous malformations

P. D. Purdy, H. Hunt Batjer, D. Samson

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Endovascular embolization procedures have undergone dramatic evolution and improvement in recent years. Despite these advances, controversy remains regarding the optimal role of these procedures in treating cerebral arteriovenous malformations (AVM's) and whether their purpose should be as a presurgical adjunct or as primary therapy. This controversy risks fragmentation between disciplines in the broader efforts to improve management of cerebrovascular disorders. The authors report seven cases of life-threatening hemorrhages that occurred during staged invasive therapy for AVM's which illustrate the value of a unified team approach to optimize patient care. Each patient underwent at least one embolization procedure using polyvinyl alcohol particles, followed in two cases by the occlusion of proximal feeding vessels by platinum microcoils and in one case by the attempted detachment of an endovascular balloon. In three patients, catheter penetration into the subarachnoid space resulted in subarachnoid hemorrhage. One patient suffered rupture of a large feeding vessel during balloon inflation. The final three patients sustained intracranial hemorrhage 2 hours, 8 hours, and 5 days, respectively, following embolization. All but two patients underwent emergency craniotomy at the time of the complication. These cases underscore the advantages of interdisciplinary management optimizing decision-making and providing expeditious care when life-threatening complications develop.

Original languageEnglish (US)
Pages (from-to)205-211
Number of pages7
JournalJournal of Neurosurgery
Volume74
Issue number2
StatePublished - 1991

Fingerprint

Arteriovenous Malformations
Intracranial Arteriovenous Malformations
Cerebrovascular Disorders
Polyvinyl Alcohol
Endovascular Procedures
Subarachnoid Space
Intracranial Hemorrhages
Craniotomy
Economic Inflation
Subarachnoid Hemorrhage
Platinum
Rupture
Decision Making
Patient Care
Emergencies
Catheters
Hemorrhage
Therapeutics

Keywords

  • arteriovenous malformation
  • embolization
  • endovascular therapy
  • hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Management of hemorrhagic complications from preoperative embolization of arteriovenous malformations. / Purdy, P. D.; Hunt Batjer, H.; Samson, D.

In: Journal of Neurosurgery, Vol. 74, No. 2, 1991, p. 205-211.

Research output: Contribution to journalArticle

@article{8c305221d8754ec588ffcdfb290f22bc,
title = "Management of hemorrhagic complications from preoperative embolization of arteriovenous malformations",
abstract = "Endovascular embolization procedures have undergone dramatic evolution and improvement in recent years. Despite these advances, controversy remains regarding the optimal role of these procedures in treating cerebral arteriovenous malformations (AVM's) and whether their purpose should be as a presurgical adjunct or as primary therapy. This controversy risks fragmentation between disciplines in the broader efforts to improve management of cerebrovascular disorders. The authors report seven cases of life-threatening hemorrhages that occurred during staged invasive therapy for AVM's which illustrate the value of a unified team approach to optimize patient care. Each patient underwent at least one embolization procedure using polyvinyl alcohol particles, followed in two cases by the occlusion of proximal feeding vessels by platinum microcoils and in one case by the attempted detachment of an endovascular balloon. In three patients, catheter penetration into the subarachnoid space resulted in subarachnoid hemorrhage. One patient suffered rupture of a large feeding vessel during balloon inflation. The final three patients sustained intracranial hemorrhage 2 hours, 8 hours, and 5 days, respectively, following embolization. All but two patients underwent emergency craniotomy at the time of the complication. These cases underscore the advantages of interdisciplinary management optimizing decision-making and providing expeditious care when life-threatening complications develop.",
keywords = "arteriovenous malformation, embolization, endovascular therapy, hemorrhage",
author = "Purdy, {P. D.} and {Hunt Batjer}, H. and D. Samson",
year = "1991",
language = "English (US)",
volume = "74",
pages = "205--211",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "2",

}

TY - JOUR

T1 - Management of hemorrhagic complications from preoperative embolization of arteriovenous malformations

AU - Purdy, P. D.

AU - Hunt Batjer, H.

AU - Samson, D.

PY - 1991

Y1 - 1991

N2 - Endovascular embolization procedures have undergone dramatic evolution and improvement in recent years. Despite these advances, controversy remains regarding the optimal role of these procedures in treating cerebral arteriovenous malformations (AVM's) and whether their purpose should be as a presurgical adjunct or as primary therapy. This controversy risks fragmentation between disciplines in the broader efforts to improve management of cerebrovascular disorders. The authors report seven cases of life-threatening hemorrhages that occurred during staged invasive therapy for AVM's which illustrate the value of a unified team approach to optimize patient care. Each patient underwent at least one embolization procedure using polyvinyl alcohol particles, followed in two cases by the occlusion of proximal feeding vessels by platinum microcoils and in one case by the attempted detachment of an endovascular balloon. In three patients, catheter penetration into the subarachnoid space resulted in subarachnoid hemorrhage. One patient suffered rupture of a large feeding vessel during balloon inflation. The final three patients sustained intracranial hemorrhage 2 hours, 8 hours, and 5 days, respectively, following embolization. All but two patients underwent emergency craniotomy at the time of the complication. These cases underscore the advantages of interdisciplinary management optimizing decision-making and providing expeditious care when life-threatening complications develop.

AB - Endovascular embolization procedures have undergone dramatic evolution and improvement in recent years. Despite these advances, controversy remains regarding the optimal role of these procedures in treating cerebral arteriovenous malformations (AVM's) and whether their purpose should be as a presurgical adjunct or as primary therapy. This controversy risks fragmentation between disciplines in the broader efforts to improve management of cerebrovascular disorders. The authors report seven cases of life-threatening hemorrhages that occurred during staged invasive therapy for AVM's which illustrate the value of a unified team approach to optimize patient care. Each patient underwent at least one embolization procedure using polyvinyl alcohol particles, followed in two cases by the occlusion of proximal feeding vessels by platinum microcoils and in one case by the attempted detachment of an endovascular balloon. In three patients, catheter penetration into the subarachnoid space resulted in subarachnoid hemorrhage. One patient suffered rupture of a large feeding vessel during balloon inflation. The final three patients sustained intracranial hemorrhage 2 hours, 8 hours, and 5 days, respectively, following embolization. All but two patients underwent emergency craniotomy at the time of the complication. These cases underscore the advantages of interdisciplinary management optimizing decision-making and providing expeditious care when life-threatening complications develop.

KW - arteriovenous malformation

KW - embolization

KW - endovascular therapy

KW - hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=0026021389&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026021389&partnerID=8YFLogxK

M3 - Article

VL - 74

SP - 205

EP - 211

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 2

ER -