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May 24-25, 2018
London, UK
Vascular Surgery 2018
3
rd
Edition of World Congress & Exhibition on
Vascular Surgery
Journal of Vascular and Endovascular Therapy
ISSN: 2573-4482
A
rteriovenous malformations (AVM) are frequently associated
withcerebral aneurysms (AA), which increase thehemorrhage
rate and associated with more unfavorable outcomes. In 91
(21.6%) patients from 421 cases of AVMs, we observed 67 (59,8
%) intranidal AA, 25 (22,3 %) flow-related AA of vessels supplying
AVMs, 17 (15,2 %) AA of the circle of Willis origin of an artery
supplying to AVM and 3 (2,7 %) AA of remote artery, that wasn’t
involved to AVM supply. Endovascular treatment with coils,
n-butylcyanoacrylate (NBCA), Onyx and Embolin was performed.
112 AA in 91 patients with AVMs were studied. Hemorrhage
was happened in 63 patients (69,2 %), seizures in 24 (26,3 %), 4
(4,5 %) patients had other symptoms. 43 (68,2 %) hemorrhages
were caused by AVM rupture with intranidal AA, 12 (19,1 %) – by
rupture of AA of vessels supplying the AVMs, 7 (11,2 %) – AA of
the circle of Willis origin of an artery supplying to the AVM, 1 (1,5
%) – remote AA that was not involved in the AVM supply. AAs
were treated during AVM endovascular treatment. 21 AA were
coiled and 82 flow-related and intranidal AA were embolized.
8 patients with AVM and 9 associated AA didn’t receive any
treatment for AA, 2 of them with 3 AA died due to terminal
coma after hemorrhage. 3 patients had fusiform AA (were left
for observation), 1 patient had proximal flow-related Anterior
Communicating Artery microaneurysmwith complicated afferent
vessels anatomy that was hard to occlude but it regressed after
subtotal AVM treatment, 2 patients reject any surgery. All 91
patients had clinical follow-up from 1 month to 12 years. One
(0,89 %) hemodynamically related AA regressed during follow-up,
and none residual AA rupture during the follow-up. 5 patients with
flow-related AA had AA de-novo. The main policy is to treat the
symptomatic lesion firstly. AA researching during AVM evaluation
should turn it in the therapeutic focus. Themethod of choice is the
simultaneous AA and AVM occlusion. Occlusion of associated
AA is critical.
Recent Publications
1. Elhammady MS, Aziz-Sultan MA, Heros RC. The
management of cerebral arteriovenous malformations
associated with aneurysms. World Neurosurg
2013;80:e123–29
2. Flores BC, Klinger DR, Rickert KL, et al. Management of
intracranial aneurysms associated with arteriovenous
malformations. Neuro- surg Focus 2014;37:E11
3. Gross BA, Du R. Natural history of cerebral arteriovenous
malformations: a meta analysis. J Neurosurg
2013;118:437– 43
4. Mohr JP, Parides MK, StapfC, et al; International ARUBA
investigators. Medical management with or without
interventional therapy for unruptured brain arteriovenous
malformations (ARUBA): a multicentre, non-blinded,
randomised trial. Lancet 2014;383: 614 –21
5. Platz J, Berkefeld J, Singer OC, et al. Frequency, risk
of hemorrhage and treatment considerations for
cerebral arteriovenous malformations with associated
aneurysms. Acta Neurochir (Wien) 2014; 156:2025–34
6. Rammos S.K., X B. Gardenghi, X C. Bortolotti, X H.J.
Cloft, and X G. Lanzino Aneurysms Associated with Brain
Arteriovenous Malformations AJNR 2016; 37: 1966-
1971
Biography
Dmitry Scheglov has extensive experience in endovascular treatment of
cerebral vascular pathology, in particular, aneurysms and malformations.
Personal experience is more than 3000 operated patients with arterial
aneurysms, arteriovenous malformations of the brain and spinal cord, ca-
Endovascular Treatment of Intracranial Aneurysms Associated
with Arteriovenous Malformations.
Dmytro V. Shchehlov
1
, Igor V. Bortnik
1
, Oleg E. Svyrydyuk
1
, Maryna Yu.
Mamonova
2
, Mykola B. Vyval
3
1
Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine, Kiev, Ukraine.
2
O. O. Bogomolets National Medical University Kiev, Ukraine.
3
Shupyk National Medical Academy of Postgraduate Education Kiev, Ukraine.
Dmytro V. Shchehlov et al., J Vasc Endovasc Therapy 2018, Volume 3
DOI: 10.21767/2573-4482-C1-003