Retrograde Transvenous Embolization of Peripheral Arteriovenous Malformations | University Hospital Halle (Saale)

Retrograde transvenous embolization with Onyx is an advanced, minimally invasive technique used to treat peripheral arteriovenous malformations (AVMs), abnormal connections between arteries and veins that bypass the normal capillary system. These malformations can cause pain, swelling, bleeding, ulceration, and functional impairment, and are often difficult to manage with conventional surgery due to their complex vascular structure and high risk of recurrence. This method focuses on blocking abnormal venous vessels, enabling precise and effective closure of the malformation. During the procedure, a specialized catheter is inserted into a vein and carefully guided under imaging control toward the venous outflow of the arteriovenous malformation. Once the catheter reaches the target area, a liquid embolic agent, Onyx, is slowly injected. Onyx is a non-adhesive, biocompatible material that solidifies gradually upon contact with blood, forming a cast within the abnormal vessels. This controlled solidification allows the physician to fill the malformation from the inside, blocking the abnormal connections and reducing or completely stopping the pathological blood flow. The retrograde transvenous approach offers important advantages compared to traditional arterial embolization. By accessing the malformation via the venous system, the technique allows better penetration of the embolic material into the core of the AVM, known as the nidus. This improves treatment effectiveness and reduces the risk of incomplete closure or recurrence. It is particularly useful in complex or high-flow malformations where arterial access alone may not provide sufficient control. This therapy is commonly used for peripheral AVMs located in the arms, legs, pelvis, or soft tissues, particularly when the malformation causes significant symptoms or complications. It can also be an option for patients who are not suitable candidates for surgery or in cases where previous treatments have failed. One of the key benefits of retrograde transvenous embolization with Onyx is its ability to selectively and permanently block abnormal vessels while preserving the surrounding healthy circulation. Because the embolic agent is delivered locally and precisely, the risk of damage to normal tissues is minimized. Additionally, the minimally invasive nature of the procedure allows for shorter recovery times and fewer complications compared to open surgical treatment.