Endovascular Neuroradiology

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ISSN / EISSN : 2304-9359 / 2663-6964
Total articles ≅ 110
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Endovascular Neuroradiology, Volume 33, pp 39-55; doi:10.26683/2304-9359-2020-3(33)-39-55

Abstract:
Objective – to improve the selection criteria and the algorithm for examining patients with chro-nic pelvic pain syndrome caused by varicose pelvis veins. Optimize the technique of embolization of ovarian veins and veins of the pelvic venous plexus, to improve the results of endovascular treatment and prevent possible complications that may arise during the embolization procedure.Materials and methods. The analysis of 24 sources of scientific and medical literature on the problem of etiology, pathogenesis, diagnostic and endovascular treatment of chronic pelvic pain syndrome in women by embolization of ovarian veins and veins of the pelvic venous plexus. The authors present their own results of endovascular treatment of 31 patients with varicose veins of the small pelvis and ovarian veins.Results. The improved patient selection criteria based on careful history taking, preoperative confirmation of ovarian and pelvic varicose veins. The technique of phlebographic examination, embolization of ovarian veins and veins of the pelvic venous plexus was optimized. The causes of complications that arise during the embolization procedure have been analyzed. Practical recommendations for endovascular surgeons are given for the prevention of such complications in the future.Conclusions. The failure of the ovarian and pelvic veins underlies the etiology of pelvis veins varicose. Pain syndrome against the background of pelvis veins varicose is the main reason for referring to gynecologists in 10–30 % of cases. Selective phlebography of the ovarian and pelvic veins has become the gold standard in the diagnosis of venous pelvic insufficiency, since only this technique is most likely to show the connection between the incompetent ovarian and internal iliac veins. Conservative therapy of pelvic congestion syndrome often turns out to be ineffective, and surgical approaches do not exclude organ loss. Endovascular surgery showed a disappearing or decrease in the clinical manifestations of chronic pelvic pain syndrome by up to 94 %, while maintaining a positive treatment result for up to 12–36 months. The main complication during embolization is the migration of the coils to the right heart and pulmonary artery. Careful adherence to the embolization technique, the correct selection of the length and diameter of the coil can minimize the occurrence of embolic complications and improve the results of treatment of chronic pelvic pain syndrome.
A.V. Byndiu, M.Yu. Orlov, M.V. Yelieinyk, S.O. Lytvak
Endovascular Neuroradiology, Volume 33, pp 66-77; doi:10.26683/2304-9359-2020-3(33)-66-77

Abstract:
Objective ‒ to analyze the effectiveness of intraoperative contact Doppler, repositioning the clip on the aneurysm and pilot clipping of the cervical aneurysm as the main methods of prevention of inadequate clipping of the cervical aneurysm in patients with intraoperative rupture of aneurysms. Materials and methods. Due to the use of intraoperative contact ultrasound Doppler control it was possible to avoid inadequate clipping of cerebral aneurysms in 16 cases, of which in 12 (75.00 %) cases ‒ incomplete clipping of cerebral aneurysms, in 3 (18.75 %) cases ‒ compression of the aneurysm’s artery-carrier, in 1 (6.25 %) case ‒ slipping of the clip with cerebral aneurysm. Perioperative examination of patients, in addition to intraoperative contact ultrasound Doppler control of radical clipping cerebral aneurysms, included clinical and neurological examination, computed tomography of the brain, cerebral angiography, ultrasound duplex scanning of the main vessels of the head and neck. In the analysis of observations of inadequate clipping of cerebral aneurysms (according to contact intraoperative Doppler), the following parameters were considered: size, location of cerebral aneurysm, timing of surgery after subarachnoid hemorrhage, anatomical forms of intracranial hemorrhage. Results. The purpose of the operations was to devascularize saccular aneurysm to prevent its re-rupture, to reduce the mass effect caused by intracerebral hematoma; reduction of intracranial pressure, rehabilitation of basal cisterns of the brain., But in the postoperative period there was a tendency to worsen the results of treatment, the appearance of focal neurological symptoms on the background of cerebral vasospasm with subsequent development of ischemic complications in patients with III‒V degree according to the Hunt‒Hess Scale on admission, in patients with prolonged temporary clipping of the cerebral aneurysm-artery and prolonged mechanical manipulation of the cerebral arteries and cerebral aneurysm. It should be noted that all patients in our sample, with complicated clipping of cerebral saccular aneurysms, had an intraoperative rupture of the MA, which complicated the process of clipping the saccular aneurysm and prolonged the time of surgery and was one of the inducers of postoperative aggravating consequences. There was a tendency to worsen the results of treatment in patients with III–IV degree according to the Hunt‒Hess Scale. Thus, patients with 1 point according to the Glasgow Outcome Scale, there were 2 patients who had II and III degrees according to Hunt–Hess Scale at hospitalization; among discharged patients with 3 point according to Glasgow Outcome Scale was dominated by patients from the second century according to Hunt‒Hess Scale at hospitalization, among patients with 5 point according to Glasgow Outcome Scale dominated patients who had I degree according to the Hunt‒Hess Scale at hospitalization. Conclusions. Inadequate clipping of the cervix cerebral aneurysm is the main type of non-hemorrhagic complications in the surgery of cerebral aneurysms. The Inadequate clipping of the cervix of the cerebral aneurysm includes the presence of residual blood flow in the cerebral aneurysm after its clipping, stenosis/compression of the main and perforating cerebral arteries with a clip, slipping of the clip from the aneurysm. Among the factors influencing the radical and adequate clipping of the cervix cerebral aneurysm are the size, location of the aneurysm, atherosclerotic lesions of the walls of the arteries and neck of the aneurysm and transferred subarachnoid hemorrhage. Reliable methods of prevention of inadequate clipping of saccular aneurysm are the use of intraoperative Doppler blood flow control, pilot clipping of complex aneurysms, optimization and individualization of surgical access. Aggravating factors that lead to unsatisfactory results of treatment of patients and negative clinical dynamics after the operation of clipping cerebral saccular aneurysm are: severe condition of the patient before surgery (III‒V gr. according to the Hunt‒Hess Scale), severe cerebral edema, intraoperative rupture of saccular aneurysm, long-term mechanical manipulations on cerebral arteries (long-term temporary clipping of saccular aneurysm, isolation of saccular aneurysm and «neighboring» cerebral arteries from arachnoid adhesions, frequent repositioning of the clip).
Yu.V. Barinov, L.O. Lysytsia
Endovascular Neuroradiology, Volume 33, pp 12-18; doi:10.26683/2304-9359-2020-3(33)-12-18

Abstract:
The simplest method of screening eye pathology in infant is red reflex examination. Present, absence or change of red reflex is key point in early detection of eye pathology. Objective – establish possibility using of mobile phone camera for eye pathology screening at home.Materials and methods. 750 children were included in research. Patient parents allowed photo their child before ophthalmology exam. First step was taking photo on parent’s mobile telephone in playing room from different distance and lighting. Second step was photo in exam room in mesopic condition in 1, 2 and 4 m distance with using maximum zoom and then ophthalmologic exam. After that, all photos was analysed by next signs: present or absence of red reflex, intensive of red reflex, present or absence pathology shadow, in case of red reflex changing, distance where changing is best viewed, comparison photo with result of ophthalmology exam. Results. After analysing photos all children was divided in three groups depending on red reflex chan-ging. In the first group red reflex was even without additional shadow, same in both eye. In this group after ophthalmology exam ametropy low level and eyelid pathology was diagnosed. In the second group red reflex was irregular by colour with additional light shadow or different intensity of red reflex in both eye. Ametropy high level was diagnosed in this group. In the third group we observed absence or colour change of red reflex. Cataract, congenital glaucoma, retinoblastoma, retinal and choroidal coloboma, Coats retinitis was diagnosed. Changing of red reflex possible to find on all photos from different distance, but the most informative was photo that was done from 1 m in mesopic condition. Conclusion. By equability and colour changing of red reflex on photo, all children may divided in three groups: 1 – children require only prophylactic ophthalmology exam, 2 – children require additional ophthalmology exam, 3 – children require immediate ophthalmology exam.
Tinglan Zuo, F.S. Glumcher, S.O. Dubrov
Endovascular Neuroradiology, Volume 34, pp 45-59; doi:10.26683/2304-9359-2020-4(34)-45-59

Abstract:
Objective ‒ to compare the hemodynamic effects and safety of the infusion of succinylated gelatin solution, sorbitol-containing solution, and 0.9 % normal saline (0.9 % sodium chloride), analyze their effect on the treatment of septic shock and mortality.Materials and methods. A prospective randomized clinical trial that included 94 adult patients with an active surgical infection and septic shock was conducted. There were 34 (36.2 %) male and 60 (63.8 %) female patients aged between 19 and 96 years, mean age was (66.51 ± 17.06) years. An appropriate solution in a volume of 500 ml was used for resuscitation, then hemodynamic and other clinical and laboratory parameters were monitored.Results. There was no significant difference in mean arterial pressure (MAP) between the 3 groups until the 40th minute (p>0.05). At the 45th minute MAP in the NS group differed only from MAP in the Gel group (p=0.007). At the 50th minute MAP in the NS group did not differ from the baseline (p=0.139). From the 50th minute to 2 hours, MAP in the Gel and Sorb groups was higher than in the NS group in all measurements (p0.05). Cardiac output (CO) did not differ up to the 30th minute (p>0.05), at the 35th minute, CO differed only between Gel and NS groups (p=0.019), from the 40th minute to 2 hour CO in Gel and Sorb groups were significantly higher than in NS group in all measurements (p0.05), from the 35th minute to the 45th minute a significant difference was found only between Gel and NS groups (p
F.S. Glumcher, Ye.Yu Dyomin
Endovascular Neuroradiology, Volume 34, pp 60-69; doi:10.26683/2304-9359-2020-4(34)-60-69

Abstract:
Objective ‒ to compare the incidence of complications and the main treatment outcomes of non-invasive mechanical ventilation (NIV) with a helmet versus NIV with a full face mask.Materials and methods. A monocentric randomized open-labeled controlled clinical trial. Patients with exacerbation of chronic obstructive pulmonary disease (COPD) with signs of respiratory failure were randomized to receive NIV through a mask or helmet. The study included 59 patients who were randomized into two groups: NIV through helmet (n = 29) or mask (n = 30). The average age of the patients was (59.24 ± 14.20) and (59.06 ± 15.90) years, respectively. In both groups men predominated ‒ 23 (79 %) and 27 (90 %) respectively. Ventilation was performed with a Draeger Carina apparatus in pressure support (PS) mode. The primary endpoint was the cumulative incidence of NIV complications. Secondary endpoints were PaO2/FiO2 ratio, tolerance to therapy, frequency of intubations, duration of stay in the intensive care unit (ICU), and ICU mortality. A total of 59 patients were involved in the study.Results. The complication rate was lower in the helmet group (10 % (n = 3) versus 43 % (n = 13), p = 0.004) and the PaO2/FiO2 ratio was higher at the first hour and at the end of NIV (253.14 ± 64.74) mm Hg versus (216.06 ± 43.86) mm Hg and (277.07 ± 84.89) mmHg versus (225.81 ± 63.64) mm Hg, p = 0.013 and p = 0.012) compared with NIV through a full face mask. More patients noted excellent helmet tolerance than masks at the 4th hour of therapy (24 (83 %) versus 14 (47 %), p = 0.004) and at the end of ventilation (69 % (20/29) versus 30 % (9/30), p = 0.03). One patient was unable to continue therapy due to mask intolerance. Differences in intubation rates, length of ICU stay, and mortality were statistically insignificant (p = 0.612, p = 0.100, p = 1.000 respectively).Conclusions. NIV through a helmet can reduce the incidence of complications and increase the PaO2/FiO2 ratio, as well as improve tolerance compared to NIV through a face mask in patients with exacerbation of COPD. A larger scale of study is needed to establish the effect of interface choice on ICU mortality, time spent in ICU, and frequency of intubation.
V.V. Moroz
Endovascular Neuroradiology, Volume 34, pp 19-33; doi:10.26683/2304-9359-2020-4(34)-19-33

Abstract:
Objective ‒ to analyze the results of surgical treatment of basilar artery (BA) bifurcation arterial aneurysms (AA), taking into account the method of BA obliteration, the type of disease, to summarize the results of surgical treatment of BA.Materials and methods. A retrospective analysis of the results of a comprehensive examination and surgical treatment of 132 patients with AA of BA bifurcation in a group of 387 operated patients with posterior cerebral circulation aneurysms, who were hospitalized and operated in the vascular departments of the State Institution Romodanov Neurosurgery Institute National Academy of Medical Sciences of Ukraine in the period from 1998 to 2019 years is made. Patients were divided into groups according to the type of disease and the method of surgical treatment of AA of BA bifurcation. The analysis of the results of surgical treatment AA of BA bifurcation was performed taking into account the method of occlusion and the clinical type.Results. The balloon occlusion technique was used in 16 (12.1 %) patients with AA of BA bifurcation, including hemorrhagic and other types of disease. Radical exclusion of AA of BA bifurcation was achieved only in 1 (6.25 %) patients of this group. Exclusion of AA of BA bifurcation at level IIR was also recorded in only 1 (6.25 %) patient. In 4 (25.0 %) patients, the level of AA occlusion corresponded to IIIR. In 10 (62.5 %) patients, after surgery using the balloon occlusion technique, AA of BA bifurcation remained not excluded. Satisfactory functional results of treatment using the balloon occlusion technique, according to mRs, were obtained in 7 (43.7 %) patients of this group, without taking into account the radicality of AA of BA bifurcation exclusion. Transcranial technique, taking into account hemorrhagic and other types of flow, was used in 5 (3.8 %) patients with AA of BA bifurcation. In 4 (80.0 %) patients of this group, radical exclusion from the bloodstream was achieved by clipping (occlusion level ‒ IR). In 1 (20.0 %) wrapping of aneurysm walls were strengthened (occlusion level ‒ AA of BA bifurcation is strengthened). Satisfactory functional treatment results in this group were obtained in 3 (60.0 %) observations. Using modern methods of aneurysm coil embolization, 111 (84.0 %) patients with AA of BA bifurcation were operated. Radical exclusion of AA from the bloodstream at the level of IR was achieved in 40 (36.0 %) patients. The level of occlusion IIR was observed in 48 (43.2 %) patients. In 26 (23.4 %) cases, the level of occlusion corresponded to IIIR. In 1 (0.9 %) case, the aneurysm was excluded at level IIID. Satisfactory functional results, according to mRs, in this group were obtained in 89 (80.2 %) observations.Conclusions. The main method of treatment of AA of BA bifurcation, regardless of the type of disease, should be considered endovascular with the use of modern methods of endovascular obliteration of aneurysm. Methods of transcranial clipping of aneurysms are possible in the surgical treatment of AA of BA bifurcation, but it is advisable to use them when it is impossible to perform endovascular intervention with modern methods of obliteration. The balloon occlusion technique is extremely ineffective in terms of radical shutdown and quality of life of operated patients with AA of BA bifurcation and can only be considered as a subject of the historical aspect of endovascular treatment of AA of BA bifurcation.
N.B. Chabanovych, M.Yu. Mamonova, S.V. Konotopchyk, D.V. Shchehlov, M.B. Vyval
Endovascular Neuroradiology, Volume 34, pp 70-81; doi:10.26683/2304-9359-2020-4(34)-70-81

Abstract:
Objective ‒ to analyze our own experience of anesthetic management during mechanical thrombectomy (MTE) in patients with acute ischemic stroke (AIS) caused by large cerebral vessels occlusion. Materials and methods. Treatment of patients with AIS caused by large cerebral vessels occlusion was carried out in accordance with the recommendations of the European Stroke Organization (ESO). MTE was performed in 63 patients (23 women and 40 men aged 36 to 82 years, mean age ‒ 62.00 ± 16.31 years). The severity of neurological symptoms in the acute period of ischemic stroke was assessed over time using the National Institutes of Health Stroke Scale (NIHSS). The degree of disability due to stroke was assessed using a modified Rankine scale (mSR) before discharge and after 90 days. The results by mRS after 90 days were the most indicative. Early ischemic changes in the brain on computed tomograms were assessed using the Alberta Stroke Program Early CT score (ASPECTS). To reduce the time «onset-to groin time» (puncture of the femoral artery), all patients were immediately sent to the operating room upon hospitalization after neuroimaging. For MTE in 50 (79 %) cases conscious sedation with local anesthesia (sibazon, fentanyl) was used, in 13 (21%) cases ‒ general anesthesia (propofol, fentanyl, atracurium besylate). Regardless of the anesthesia method, vital signs were monitored and postoperative complications were assessed. The assessment of other important indicators related to the expiration of anesthesia was carried out: the time «onset-the the groin time» the time «from groin – to recanalization», the level of saturation, the stability of mean arterial pressure, the use of vasopressors or labetolol, the number of postoperative complications (pneumonia, dislocation with decompression craniotomy, nausea, myocardial infarction). Results. The algorithm for anesthetic management of the perioperative period included the anesthesia during MTE, postoperative anesthetic monitoring and correction of deviations over the next 72 hours. Mandatory components of anesthetic support of MTE were to maintain blood pressure of at least 140/90 mm Hg. before reperfusion and FiO2 0.45‒0.5%. Anesthetic management also included infusion therapy, prevention of vomiting and regurgitation, and symptomatic therapy. Special attention was paid to the control of hemodynamics in the postoperative period. The results of treatment according to mRS after 90 days showed that more than half of the patients ‒ 32 (50.8%) after MTE were independent of outside help (0‒2 points), 24 (38.1 %) ‒ 3‒5 points, 6 points (mortality) ‒ 7 (11.1 %). After general anesthesia during MTE, 2 (15.4 %) deaths were registered, after MTE with conscious sedation using ‒ 5 (10.0%). There more patients with the vasopressors or labetalol using and the number of postoperative pneumonia were identified in the group with general anesthesia. For other indicators, there was no statistically significant difference in the results depending on the type of anesthesia. There was no statistically significant difference in the results in depending on anesthesia method. Conclusions. The choice of the anesthesia method during MTE for large cerebral vessels should be individual. There was no statistically significant difference in the results in treatment of patients with AIS using MTE (in particular, in mortality), depending on the type of anesthetic management. It is also wasn’t found in the time «onset – to groin time» and the time «groin – to recanalization» with various methods of anesthesia. Indications of vital functions, saturation, mean arterial pressure in patients did not have a significant difference. Differences were revealed in terms of the vasopressors or labetolol using and the number of postoperative pneumonia, depending on the anesthesia type. The anesthesia team should be involved in patient management from the moment of hospitalization, regardless of the method of anesthesia. The results of AIS treatment depend on the initial NIHSS and ASPECTS scores, comorbidity, collateral development, perioperative complications, and the degree of reperfusion after surgery. Special attention should be paid to hemodynamics before and after reperfusion recovery after vessel recanalization, taking into account the degree of reperfusion. The influence of the type of anesthesia on the results of the treatment of AIS with the MTE using remains under the further discussion.
E.G. Pedachenko, V.V. Moroz, V.A. Yatsyk, U.I. Malyar, , D.M. Egorova
Endovascular Neuroradiology, Volume 33, pp 83-93; doi:10.26683/2304-9359-2020-3(33)-83-93

Abstract:
Stroke is a global medical and socio-economic problem and a great demand for alternative therapies, the leading one being stem cell (SC) therapy. Pathogenetic processes in ischemic stroke (II) trigger the mechanisms of necrotic and apoptotic death of neurons with the formation of the central infarct zone («core of ischemia») and the ischemic «penumbra» zone; the severity and reversibility of the injury directly depends on the duration of ischemia. In parallel with pathogenetic processes, endogenous neurogenesis occurs – the proliferation of neurogenic stem and progenitor cells (NSC/NPC) and their migration into the ischemic focus; however, most NSCs and newly formed neurons undergo apoptosis and recovery of lost functions does not occur. Significant efforts are being made to find ways to control neurogenesis, in particular through the transplantation of exogenous SCs. The main factors preventing the use of SCs in humans are moral, ethical, religious and legal aspects related to the source and method of obtaining cells, as well as possible immunocompromised complications due to incompatibility of donor cells with the recipient of the main histocompatibility complex antigens. The safest is the use of autologous SCs (the patient’s own cells), as it does not require the use of immunosuppressive protocols. Due to the relative safety and ease of production, the most common are multipotent mesenchymal stem cells (MSCs), namely MSCs of the bone marrow (BM). Numerous preclinical studies in experimental animals with modeled II, as well as clinical trials conducted over the past 15 years, have shown the safety and feasibility of transplantation of autologous MSCs in patients with severe neurological deficits after II. Two different approaches to the use of MSCs are discussed: neuroprotection in the acute phase and neurorestoration in the chronic phase II. Proposals are currently being developed for phase II/III clinical trials in acute and chronic stroke using BM MSCs, the results of which will form the basis for certified standardized II treatment protocols.
L.V. Havrylova
Endovascular Neuroradiology, Volume 33, pp 56-65; doi:10.26683/2304-9359-2020-3(33)-56-65

Abstract:
Objective ‒ to maintain the adequate sedation and analgesia without respiratory depression in children up to 4 years old with spinal cord pathology in early postoperative period (first 3 days) in inpatient department; to decrease digestive system motor function depression; to exclude aspiration possibility; to start early children’s natural feeding in postoperative period.Materials and methods. From October 2019 to January 2020 dexmedetomidine sedation was performed by the prolonged infusion administration to 10 children (6 children aged 6 month to 1 year and 4 children up to 4 years) with spinal cord and vertebral pathology (spina bifida, meningomyelocele, myelocele, teratoma, lipoma of lumbar spine) in early postoperative period at intensive observation ward of neurosurgical department. During the first three days after the surgery and dexmedetomidine prescription the vital functions monitoring was being performed for 24 hours. Arterial blood pressure, heart rate, blood saturation have been scheduled by one of the parents. The immediate access to oxygen and parent’s permission for using this sedation method were the obligatory requirements.Results. The appropriate sedation target was achieved after the dexmedetomidine prescription for the children with the spinal cord and vertebral pathology in early postoperative period at intensive observation ward of neurosurgical department; the dosage of opioid analgesics was successfully decreased by 50 %. The respiratory depression was not observed. The blood pressure and bradycardia were not haemodynamically significant. Swallowing reflex was saved, which led to early physiological nutrition and excluded aspiration risk. The following transfer of patients after the surgery to the neurosurgical department bypassing ICU reduced the financial expenditure of the hospital.Conclusions. Dexmedetomidine provides with the adequate sedation in early postoperative period and can be recommended for the usage in children with the spinal cord and vertebral pathology as the safest medication due to minimal cardio-respiratory complications during moderately prolonged prescribed period.
D.V. Shchehlov, , I.V. Altman, N.V. Kiselyova, I.I. Kashkish
Endovascular Neuroradiology, Volume 34, pp 95-104; doi:10.26683/2304-9359-2020-4(34)-95-104

Abstract:
The objective – to presents the observation of combined treatment of a patient with arteriovenous malformation of the lower jaw.A man, 21 years old, was hospitalized in the Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine with complaints of bleeding from a tooth socket after an attempt to remove the 6th tooth (first painter) of the lower jaw on the left. According to the performed survey radiography of the lower jaw, an aneurysmal bone cyst was revealed in the body of the lower jaw on the left, corresponding to the localization of bleeding. According to cerebral angiography, an arteriovenous malformation of the lower jaw was revealed on the left, the afferent arteries of which were: the right facial artery (a branch of the right external carotid artery (ECA)), the left facial artery (a branch of the left ECA), the lower alveolar artery, the superior-posterior alveolar artery (branches of the maxillary artery ‒ the terminal branch of the left ECA) with drainage into a vein, which was located in the body of the lower jaw. In order to exclude the malformation from the bloodstream and prevent bleeding, a controlled embolization of the malformation was performed using non-spherical emboli – polyvinyl alcohol (PVA) particles from Cook, USA. Using a transfemoral approach, a guide catheter was inserted into the orifice of the ECA, then a Headway 27 microcatheter (Microvention, USA) was passed through it along a Traxes 14 guide wire (Microvention, USA), the afferent arteries of the malformation were selectively cathete-rized in turn, and embolization was performed after superselective angiography. The patient was discharged in a satisfactory condition. Two weeks after the operation, the bleeding resumed. The performed control cerebral angiography revealed a relapse of the malformation with a change in its angioarchitectonics ‒ the filling of the malformation in the late arterial and venous phases of cerebral blood flow was noted. Re-embolization was performed using PVA emboli (Cook), which was supplemented by transcutaneous puncture of the drainage vein in the mandible and its embolization with histoacryl (B. Braun, Germany) and lipiodol (Guerbet, France) in a 1 : 1 ratio. Results. As a result of using this technique, it was possible to turn off the malformation completely. For 6 months from the moment of surgery, no bleeding was noted, and subsequently the patient had a tooth removed without complications.Conclusions. The proposed method for treating arteriovenous malformation of the lower jaw, proposed in this case, showed the effectiveness of a combination of endovascular embolization in combination with transcutaneous embolization of the draining vein and can be successfully used to treat this pathology.
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