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501 East Hampden Avenue - Suite 4600
Englewood, CO 80113
P: 303-788-4280  |  F: 303-788-4412
E: Info@YakesVascularMalformationCenter.com

© 2016 by The Yakes Vascular Malformation Center. All Rights Reserved

Endovascular embolization is a minimally invasive procedure in which substances are injected in to the malformation to thrombose and occlude the malformation, thus limiting or blocking the blood flow to the lesions thereby reducing symptoms.

 

In 1986, Dr. Yakes et al described curative treatment for the first time of a massive extremity and pelvis AVM with 98% Ethyl alcohol or ethanol. Since then, it has become increasingly apparent that ethanol embolotherapy for vascular malformations of all types can be curative, especially for large complex AVMs that surgery or other embolization treatments are impossible to manage. Ethanol is a powerful sclerosing agent that denatures blood proteins and destroys the endothelial cells in the vessel wall effectively destroying the abnormal vascular mass and preventing its ability to regenerate. Ethanol is injected either by direct puncture techniques, via a very small catheter which is directed in to the malformation itself, or through a catheter which is inserted within a vessel leading to the malformation. Typically, vascular malformations require serial treatments to cure. In those patients with pain syndrome, serial devascularization of the malformation will usually reduce the amount of pain the patient suffers. After serial therapy, MRI can be used to document the efficacy of therapy.

Ethanol offers significant promise for the patients afflicted with these disorders and it is now believed to be the agent of choice for vascular malformation endovascular therapy by many centers. Ethanol treatment of vascular malformations requires significant experience with the agent, as well as extreme caution and a complete understanding of the pathophysiology of the anatomy and of the vascular malformation being treated. We believe that these abnormalities should be treated only in high volume vascular malformation centers that have expertise in this particular treatment.

How do we treat Vascular Malformations?

What are alternatives to Ethanol Embolization?

Vascular malformations were initially treated with surgery, however complete removal of the malformation proved very difficult due to its interconnectedness with nearby structures like bones, nerves, muscles etc. Surgical excision also proved to be very hazardous in that massive hemorrhage during surgery often occurred. Partial resections could cause an initial good clinical response, but with time, the patient’s symptoms usually recurred and worsened. Different substances have been used including glues, Onyx, coils and Gelfoam, however, the majority of malformations recurred after embolization with these substances just as they did after surgery through a process called neovascular recruitment phenomena and angiogenesis: when new blood vessels form from pre-existing vessels.