Endovascular Treatment of Arteriovenous Malformations Using Ethylene Vinyl Alcohol Copolymer

  • Bruno C. Flores
  • Bradley A. Gross
  • Felipe C. AlbuquerqueEmail author


Over the past two decades, endovascular embolization has become a fundamental part of a multidisciplinary approach for the treatment of intracranial arteriovenous malformations (AVMs). Several embolic agents are now an intrinsic part of the neurointerventional armamentarium. However, none has represented as remarkable an improvement as the introduction of ethylene vinyl alcohol copolymer (EVOH). In conjunction with n-butyl cyanoacrylate (NBCA), EVOH has revolutionized the endovascular management of intracranial AVMs because of its ability to systematically deliver a sufficient volume of the embolic agent to the nidus and pedicles without extension into the venous drainage. The clinical decision to treat an AVM is facilitated by preoperative risk stratification; the first question to be addressed is whether to treat the AVM; and, if so, the second question is how to treat it. Endovascular EVOH embolization is primarily applied as an adjunct treatment to microsurgical resection or radiosurgery. Few cases are amenable to angiographic cure by embolization alone. The goal of this chapter is to describe the pertinent properties, endovascular techniques, and pitfalls for the endovascular management of intracranial AVMs using EVOH.


Arteriovenous malformations Embolization Ethylene vinyl alcohol copolymer Onyx 



Anterior cerebral artery


Arteriovenous malformation


Conformité Européenne


Dimethyl sulfoxide


Ethylene vinyl alcohol copolymer


US Food and Drug Administration


Liquid embolic system


Middle cerebral artery


n-butyl cyanoacrylate


Posterior cerebral artery



The authors thank the editorial staff of the Neuroscience Publications office of Barrow Neurological Institute for their invaluable assistance with the production of this chapter, without whom this work would not have been possible.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Bruno C. Flores
    • 1
  • Bradley A. Gross
    • 1
  • Felipe C. Albuquerque
    • 2
    Email author
  1. 1.Department of NeurosurgeryBarrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenixUSA
  2. 2.c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph’s Hospital and Medical CenterPhoenixUSA

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