Question

Describe complications during embolization of brain arteriovenous malformations with ethylene vinyl hydroxide (EVOH) liquid embolic agents.

Hint:

Careful monitoring and appropriate technique during embolization can minimize complications and improve patient outcomes.

Answer 1

Embolization of brain arteriovenous malformations (AVMs) using ethylene vinyl hydroxide (EVOH) liquid embolic agents is a widely used technique, but it can lead to complications.
Step 1: Complication - Incomplete Embolization:
- In some cases, the embolic agent may not adequately fill the entire nidus, resulting in incomplete occlusion and persistence of the AVM.
Step 2: Complication - Reflux and Non-target Embolization:
- If the EVOH agent refluxes into normal brain tissue, it can cause ischemia, infarction, or tissue necrosis, potentially resulting in severe neurological deficits.
Step 3: Complication - Allergic Reactions:
- Although rare, allergic reactions to the embolic agents may occur, leading to symptoms like rash, fever, or anaphylaxis.
Step 4: Complication - Post-Embolization Syndrome:
- This includes fever, headache, nausea, and sometimes neurological deficits, which can occur in the days following embolization.
Step 5: Complication - Hemorrhage:
- There is a risk of hemorrhage, especially in cases where the embolization agent does not fully occlude the AVM or in the presence of large, high-flow AVMs.