Presenter: Shiro Onozawa

Hospital: Kyorin University Faculty of Medicine, Tokyo, Japan

Summary

A 10-year-old male with a giant Type II neck AVM and heart failure (BNP 578.2 pg/mL) underwent venous embolization targeting the dominant outflow vein (DOV) using the pressure cooker technique. Post-procedural BNP dropped to 29 pg/mL, with complete resolution of cardiac symptoms. This case highlights the efficacy of DOV-focused embolization in complex AVMs.

Introduction

Neck arteriovenous malformations (AVMs) may induce high-output heart failure. Conventional arterial embolization often fails due to collateral recruitment. Type II AVMs (Cho-Do classification) are characterized by dominant outflow veins (DOVs), which, when targeted via venous embolization, can achieve complete occlusion.

Case analysis

Clinical Profile: Neck swelling, heart failure (BNP 578.2 pg/mL), failed prior arterial embolizations.

Imaging: CTA confirmed Type II AVM with three DOV tributaries.

Procedure:

•Percutaneous DOV access with coil embolization and NBCA glue injection (pressure cooker technique).

•Post-procedure BNP decreased to 29 pg/mL.

•Key Insight: Direct DOV embolization minimizes collateral recruitment.

Conclusion

Venous embolization is a definitive approach for Type II AVMs, particularly when arterial interventions fail. The pressure cooker technique ensures controlled glue delivery, reducing non-target embolization.