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Percutaneous embolization of arteriovenous malformations at the plantar aspect of the foot
Wayne Yakes, MD, Marc Huguenot, MD, Alexis Yakes, Alexander Continenza, MD, Raphael Kammer, MD, Iris Baumgartner, MD Journal of Vascular Surgery Volume 64, Issue 5, Pages (November 2016) DOI: /j.jvs Copyright © 2015 Society for Vascular Surgery Terms and Conditions
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Fig 1 Patient 1. A, Incomplete occlusion of ateriovenous malformation (AVM) by intra-arterial embolization of feeder arteries using Onyx (ev3 Endovascular Inc, Plymouth, Minn) and Histoacryl (TissueSeal, LLC, Ann Arbor, Mich) in B, Critical foot ischemia after treatment. C, Follow-up arteriography with innumerable collaterals maintaining persistent type IIIB AVM in D, Direct puncture arteriography of Yakes type IIIb AVM nidus using a 18-gauge needle and intra-aneurysmal vein coiling using eight fibered coils of inch size, 6-mm diameter and three fibered coils of inch size, 4-mm diameter sizes, followed by injection of 4.5 mL of 96% ethanol. E, Arteriographic follow-up at 1 year shows complete occlusion of the AVM being treated, merely a clinically irrelevant, second AVM compartment was noted (arrow). Journal of Vascular Surgery , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions
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Fig 2 Patient 2. A, Clinical aspect of the right foot before treatment. B, Arteriogram before showing Yakes type IIIb arteriovenous malformation (AVM). C, Result after direct puncture intra-aneurysmal vein coiling using five fibered coils of inch size and 10-mm diameter, and four fibered coils of inch size and 8-mm diameter, followed by 25 mL of 96% ethanol. D, Clinical follow-up after surgical removal of coils. Journal of Vascular Surgery , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions
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Fig 3 Patient 3. A, Intra-arterial and (B) direct puncture arteriogram of Yakes type IIIb arteriovenous malformation (AVM) with 18-gauge needles. (C) Complete occlusion of the Yakes type IIIb AVM with adjacent, additional infiltrative Yakes type IV AVM becoming obvious at 10 weeks of follow-up. D, Direct puncture injections in the AVM microfistulas, when a feeding arterial pedicle was direct punctured, then 50%-50% ethanol was injected. E, Final arteriogram with occlusion of Yakes type IIIB AVM and nearly complete disappearance of the Yakes type IV AVM. Journal of Vascular Surgery , DOI: ( /j.jvs ) Copyright © 2015 Society for Vascular Surgery Terms and Conditions
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