Embolotherapy for High-Flow Arteriovenous Malformations in the Hands Using Absolute Ethanol with Coil-Assisted Dominant Outflow Vein Occlusion

Abstract Purpose The purpose of this study was to evaluate the management, outcomes, and technical and clinical safety of coil-assisted dominant outflow vein (DOV) occlusion for the ethanol embolization of high-flow arteriovenous malformations (AVMs) in the hands. Materials and Methods Between March 2013 and October 2016, 12 consecutive patients with AVMs with DOVs underwent ethanol embolization combined with detachable and pushable coil-assisted DOV occlusion. All patients completed the course of clinical follow-up (range: 14–57 months; mean: 36.7 months), and imaging follow-up (range: 8–25 months; mean: 16.6 months) results from the final treatment session were available for 8 patients. The therapeutic effects, degree of devascularization, and complications at the time of follow-up arteriography were evaluated as the clinical outcomes. Results The patients underwent 23 ethanol embolization procedures (range: 1–3; mean, 1.9) with 24 detachable coils and 223 pushable coils. The average stretched length of the total coils per patient was 320.17 cm. Seven of 12 patients (58.3%) exhibited complete responses, and 5 patients (41.7%) exhibited partial responses. Minor complications, including blistering and focal swelling, occurred in all 12 patients (100%) but showed spontaneous and complete recovery. No major complications occurred. Conclusions Ethanol embolization has the potential to control high-flow hand AVMs by using coil-assisted DOV occlusion with an acceptable risk of minor and major complications.