Safety and effectiveness of Ethylene-Vinyl Alcohol Copolymer embolization of peripheral high flow arteriovenous malformations - results of a prospective study.

Abstract: Purpose To prospectively evaluate the efficacy and safety of a new Ethylene Vinyl Alcohol Copolymer (EVOH) based embolization agent in the treatment of symptomatic peripheral arteriovenous malformations (AVM). Materials and Methods This prospective single-center study evaluated EVOH embolization with three different formulations of EVOH (Squidperi 12, 18, 34) in patients with symptomatic AVM. Between April 2018 and October 2019, 36 embolization procedures in 21 patients (3 males, 18 females; mean age 34.7) were performed (inclusion criteria: symptomatic peripheral AVM, ≥ 14years, elective embolization). Symptoms, technical aspects (transarterial, transvenous or percutaneous approach; plug or balloon occlusion), clinical and technical success (defined as improvement of symptoms and complete angiographic occlusion of AVM nidus), complications and short-term outcomes were assessed. Results The mean volume of embolization agent used per session was 3.4 ml of EVOH 34 (Standard deviation (SD) 5.4), 6.2 ml of EVOH 18 (SD 8.1) and 4.6 ml of EVOH 12 (SD 10.1). Angiographic success was achieved in 85.7% of the patients. Mean follow-up was 190 days (from 90 to 538, median 182). In follow-up assessment, MRI showed 90.5% had a persistent state of devascularization compared to postinterventional angiography. Amelioration of pain or complete painlessness was achieved in 90.0% of the patients. 1 patient experienced a major complication, 2 patients developed minor complications. Conclusions In our study, EVOH appears to be a safe and effective embolization agent in peripheral AVMs and has a low rate of complications in a limited number of patients.