Clinical and angiographic characteristics of patients
| Patient No. (Figure No.) | Age/Sex | Location | Main Symptoms | Type | Access | Reason to Use Onyx | Assist Technique | Outcome | Notes |
|---|---|---|---|---|---|---|---|---|---|
| 1 (Figure 1) | 21/M | L periorbital | Painful pulsatile mass totally obstructing vision | vm | IA × 3 PC | Anticipation of better penetration into the nidus of the malformation with IA injection and direct puncture | Balloon, direct puncture of draining vein remote to fistula | Total removal after 2 series of embolizations and surgeries | Catheter tip retained and removed later during surgery, difficulty in balloon retrieval, supplemented with glue for cost containment purposes and also for direct puncture of draining vein |
| 2 | 24/F | L cheek | Painful mass, cosmetic concerns | vm | IA × 1 | Anticipation of better penetration into the nidus of the malformation with IA injection | Balloon | Residual AVM | Incomplete treatment, patient unwilling to pursue further treatment |
| 3 | 10/M | At mentum of mandible | Mass with intermittent bleeding | vm | IA × 2 | Anticipation of better penetration into the nidus of the malformation with IA injection | Total elimination of malformation | Small AVM, bilateral facial approach, no surgery, catheter tip retained on one side | |
| 4 | 7/M | L preauricular | Enlarging PM | fs | IA × 1 | Plan to use external compression to limit embolization to the exact point of fistula under controlled injection to avoid excessive venous filling & arterial reflux | EC on both arterial and venous side of AVF | Total elimination of shunt | |
| 5 | 9/M | R angle of mandible | Enlarging PM | fs | IA × 1 TV in session 1, PC for 2nd session | Plan to use balloon assist | Balloon for session 1, venous EC for both sessions | Total elimination of shunt after 2 sessions of embolization | Significant filling of lesion through collaterals after session 1, glue used during second session to fill in large venous pouch |
| 6 (Figure 2) | 25/F | R zygoma | Bruit, PM | fs | IA × 1 | Plan to use balloon assist | Balloon | Total elimination of shunt | |
| 7 | 26/M | L temple | fs | PC | Anticipation of retrograde filling of feeders | Venous EC | Total elimination of shunt | Surgical excision of cast | |
| 8 (Figure 3) | 33/M | L occipital | Painful large scalp mass | fs | PC | Anticipation of retrograde filling of feeders | Venous EC | Total elimination of shunt | Surgical excision of cast |
| 9 (Figure 4) | 24/M | L forehead | Cosmetic concerns | fs | PC | Anticipation of retrograde filling of feeders | Venous EC | Total elimination of shunt | Surgical excision of cast, second surgery for blackish discoloration at injection site |
Note:—M indicates male; F, female; L, left; R, right; PM, pulsatile mass; vm or AVM, arteriovenous malformation; AVF, arteriovenous fistula; fs, fistulous lesion; IA, intra-arterial; PC, percutaneous; TV, transvenous; EC, external compression.