• 1. Legiehn GM, Heran MK. Classification, diagnosis, and interventional radiologic management of vascular malformations. Orthop Clin North Am 2006; 37: 435474.

    • Search Google Scholar
    • Export Citation
  • 2. Lidsky ME, Markovic JN & Miller MJ Jr, et al. Analysis of the treatment of congenital vascular malformations using a multidisciplinary approach. J Vasc Surg 2012; 56: 13551362.

    • Search Google Scholar
    • Export Citation
  • 3. Mulliken JB & Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 1982; 69: 412422.

    • Search Google Scholar
    • Export Citation
  • 4. Burrows PE, Mulliken JB & Fellows KE, et al. Childhood hemangiomas and vascular malformations: angiographic differentiation. AJR Am J Roentgenol 1983; 141: 483488.

    • Search Google Scholar
    • Export Citation
  • 5. Gloviczki P, Duncan A & Kalra M, et al. Vascular malformations: an update. Perspect Vasc Surg Endovasc Ther 2009; 21: 133148.

  • 6. Jackson IT, Carreno R & Potparic Z, et al. Hemangiomas, vascular malformations, and lymphovenous malformations: classification and methods of treatment. Plast Reconstr Surg 1993; 91: 12161230.

    • Search Google Scholar
    • Export Citation
  • 7. Tan KT, Simons ME & Rajan DK, et al. Peripheral high-flow arteriovenous vascular malformations: a single-center experience. J Vasc Interv Radiol 2004; 15: 10711080.

    • Search Google Scholar
    • Export Citation
  • 8. Puig S, Casati B & Staudenherz A, et al. Vascular low-flow malformations in children: current concepts for classification, diagnosis and therapy. Eur J Radiol 2005; 53: 3545.

    • Search Google Scholar
    • Export Citation
  • 9. Kohout MP, Hansen M & Pribaz JJ, et al. Arteriovenous malformations of the head and neck: natural history and management. Plast Reconstr Surg 1998; 102: 643654.

    • Search Google Scholar
    • Export Citation
  • 10. Cahill AM, Nijs EL. Pediatric vascular malformations: pathophysiology, diagnosis, and the role of interventional radiology. Cardiovasc Intervent Radiol 2011; 34: 691704.

    • Search Google Scholar
    • Export Citation
  • 11. Hosgood G. Arteriovenous fistulas: pathophysiology, diagnosis, and treatment. Compend Contin Educ Pract Vet 1989; 11: 625636.

  • 12. Bolton GR, Edwards HJ, Hoffer RE. Arteriovenous fistula of the aorta and caudal vena cava causing congestive heart failure in a cat. J Am Anim Hosp Assoc 1976; 12: 463469.

    • Search Google Scholar
    • Export Citation
  • 13. Allison DJ & Kennedy A. ABC of vascular diseases. Peripheral arteriovenous malformations. BMJ 1991; 303: 11911194.

  • 14. Vaidya S, Tozer KR & Chen J. An overview of embolic agents. Semin Intervent Radiol 2008; 25: 204215.

  • 15. Saunders AB, Fabrick C & Achen SE, et al. Coil embolization of a congenital arteriovenous fistula of the saphenous artery in a dog. J Vet Intern Med 2009; 23: 662664.

    • Search Google Scholar
    • Export Citation
  • 16. Bussadori R, Bussadori C & Millan L, et al. Transvenous coil embolisation for the treatment of single congenital portosystemic shunts in six dogs. Vet J 2008; 176: 221226.

    • Search Google Scholar
    • Export Citation
  • 17. Dickey KW, Pollak JS & Meier GH III, et al. Management of large high-flow arteriovenous malformations of the shoulder and upper extremity with transcatheter embolotherapy. J Vasc Interv Radiol 1995; 6: 765773.

    • Search Google Scholar
    • Export Citation
  • 18. Arat A, Cil BE & Vargel I, et al. Embolization of high-flow craniofacial vascular malformations with Onyx. AJNR Am J Neuroradiol 2007; 28: 14091414.

    • Search Google Scholar
    • Export Citation
  • 19. van Rooij WJ, Sluzewski M, Beute GN. Brain AVM embolization with Onyx. AJNR Am J Neuroradiol 2007; 28: 172178.

  • 20. Guimaraes M & Wooster M. Onyx (ethylene-vinyl alcohol copolymer) in peripheral applications. Semin Intervent Radiol 2011; 28: 350356.

    • Search Google Scholar
    • Export Citation
  • 21. Germanwala AV, Vora NA & Thomas AJ, et al. Ethylenevinylalcohol copolymer (Onyx-18) used in endovascular treatment of vein of Galen malformation. Childs Nerv Syst 2008; 24: 135138.

    • Search Google Scholar
    • Export Citation
  • 22. Huang Q, Xu Y & Hong B, et al. Use of Onyx in the management of tentorial dural arteriovenous fistulae. Neurosurgery 2009; 65: 287293.

    • Search Google Scholar
    • Export Citation
  • 23. Natarajan SK, Ghodke B & Kim LJ, et al. Multimodality treatment of intracranial dural arteriovenous fistulas in the Onyx era: a single center experience. World Neurosurg 2010; 73: 365379.

    • Search Google Scholar
    • Export Citation
  • 24. Vanninen RL & Manninen I. Onyx, a new liquid embolic material for peripheral interventions: preliminary experience in aneurysm, pseudoaneurysm, and pulmonary arteriovenous malformation embolization. Cardiovasc Intervent Radiol 2007; 30: 196200.

    • Search Google Scholar
    • Export Citation
  • 25. Cantasdemir M, Gulsen F & Solak S, et al. The use of Onyx for embolization of peripheral vascular malformations in pediatric patients. Pediatr Surg Int 2012; 28: 477487.

    • Search Google Scholar
    • Export Citation
  • 26. Nogueira RG, Dabus G & Rabinov JD, et al. Preliminary experience with Onyx embolization for the treatment of intracranial dural arteriovenous fistulas. AJNR Am J Neuroradiol 2008; 29: 9197.

    • Search Google Scholar
    • Export Citation
  • 27. Numan F, Omeroglu A & Kara B, et al. Embolization of peripheral vascular malformations with ethylene vinyl alcohol copolymer (Onyx). J Vasc Interv Radiol 2004; 15: 939946.

    • Search Google Scholar
    • Export Citation
  • 28. Toker ME, Eren E & Akbayrak H, et al. Combined approach to a peripheral congenital arteriovenous malformation: surgery and embolization. Heart Vessels 2006; 21: 127130.

    • Search Google Scholar
    • Export Citation
  • 29. Aiken SW, Jakovljevic S & Lantz GC, et al. Acquired arteriovenous fistula secondary to castration in a dog. J Am Vet Med Assoc 1993; 202: 965967.

    • Search Google Scholar
    • Export Citation
  • 30. Butterfield AB, Hix WR & Pickrel JC, et al. Acquired peripheral arteriovenous fistula in a dog. J Am Vet Med Assoc 1980; 176: 445448.

  • 31. Ettinger S, Campbell L & Suter PF, et al. Peripheral arteriovenous fistula in a dog. J Am Vet Med Assoc 1968; 153: 10551058.

  • 32. Tobias KM, Cambridge A & Gavin P. Cyanoacrylate occlusion and resection of an arteriovenous fistula in a cat. J Am Vet Med Assoc 2001; 219: 785788.

    • Search Google Scholar
    • Export Citation
  • 33. Chanoit G, Kyles AE & Weisse C, et al. Surgical and interventional radiographic treatment of dogs with hepatic arteriovenous fistulae. Vet Surg 2007; 36: 199209.

    • Search Google Scholar
    • Export Citation
  • 34. Easley JC, Carpenter JL. Hepatic arteriovenous fistula in two Saint Bernard pups. J Am Vet Med Assoc 1975; 166: 167171.

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Use of ethylene-vinyl alcohol copolymer as a liquid embolic agent to treat a peripheral arteriovenous malformation in a dog

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  • 1 Departments of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616
  • | 2 Sutter Imaging, Interventional Radiology, 2801 K St, Ste 502, Sacramento, CA 95816
  • | 3 Departments of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616
  • | 4 Departments of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616

Abstract

Case Description—An 11-year-old castrated male Tibetan Mastiff was evaluated because of a visibly enlarged blood vessel and progressively worsening swelling of the right hind limb.

Clinical Findings—On physical examination, the right hind limb was markedly larger than the left hind limb and the dog was minimally weight bearing on the affected limb. A bruit was auscultated over the affected region. Ultrasonography of the tarsal region of the right hind limb revealed an artery with turbulent flow that communicated with venous drainage. A CT scan confirmed the presence of an arteriovenous malformation (AVM).

Treatment and Outcome—Embolization of the AVM with a liquid embolic agent (ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide) was elected. An arteriogram was performed prior to treatment and delineated the vessels that were targeted for embolization. The embolic agent was infused into the AVM, and a postinjection arteriogram confirmed complete occlusion of the AVM nidus and normal arterial flow to the paw with subsequent normal venous drainage. The circumference of the abnormal paw was 51 cm before the procedure and 22.9 cm at 4 weeks after the procedure. Additionally, the gait of the dog dramatically improved. No complications associated with the procedure developed.

Clinical Relevance—Peripheral AVMs in dogs are uncommon, and described treatment options are limited and generally associated with serious morbidity. A liquid embolic agent, ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide, was successfully administered in this case, and no morbidity was observed secondary to the procedure. Clinical success was characterized by substantial improvement in limb swelling and marked improvement in the gait of the dog.

Contributor Notes

No funding was received.

Presented in part at the Veterinary Endoscopy Society Meeting, San Pedro, Belize, May 2011.

The authors thank John Doval for technical assistance.

Address correspondence to Dr. Culp (wculp@ucdavis.edu).