Silk Suture Embolization of High Flow Vascular Malformations

Abstract

The extremely high flow rates observed in some vascular malformations reduce the probability of embolic agents within the nidus and increase the probability of deposition of embolic agents on the venous side. Reduction of flow helps to assure successful embolization of the nidus. For safety during embolization, a superselective catheter position within the feeding pedicles must be achieved, requiring a very distal placement of a microcatheter. Only liquids and solids with a tiny cross section can pass through a microcatheter. We have found silk suture material both easy to inject through a microcatheter and effective in reducing the flow rates of high flow lesions. Following substantial reduction of flow with silk, small particulate emboli are often used to further embolize. We have successfully used the Tracker microcatheter system to deliver silk suture emboli to high flow vascular malformations in more than 20 patients. Angiographie and pathologic follow-up will be presented.