Transvenous Embolization Technique for Brain Arteriovenous Malformations

Transvenous embolization is potentially curative for small AVMs with favorable anatomic features, such as inaccessible arterial feeders, deep location, and/or a single draining vein. Successful embolization requires the control of arterial blood flow and successful navigation of the draining vein. This allows permeation of the embolizate into the nidus. Arterial inflow may be controlled using a hypercompliant balloon or systemic hypotension. We have described the use of transvenous rapid ventricular pacing and adenosine to achieve transient controlled hypotension. This requires a multidisciplinary approach, yet provides high chances of complete obliteration of the AVM.