Staged, office-based treatment of debilitating, limb-threatening hand arteriovenous malformations with a Venaseal cyanoacrylate-based embolization strategy

The aim of this study was to demonstrate a novel, office-based treatment of life-threatening hand arteriovenous malformations (AVMs) via Venaseal cyanoacrylate embolization. Two adult male patients with debilitating Yakes II hand AVMs underwent staged, transarterial, and direct-stick Venaseal embolization in an office-based setting over a period of 12 (7 sessions) and 8 (4 sessions) months. Technical success was 100% with no complications. Clinical success was achieved with ulcer and cardiopulmonary overload alleviation, nonrestricted restoration of hand function, and reduction in lesion volume confirmed by Doppler flow rate measurements. Interim results after 9-month follow-up revealed sustained relief with no recurrence clinically or ultrasonographically. We present a novel, office-based approach to safe, effective, and durable embolization of advanced hand AVMs using Venaseal cyanoacrylate and have found AVM nidal flow rate measurements on Doppler useful for objective assessment of AVM hemodynamics and response to treatment.