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09-04-2024 | Venous Thrombosis | Original Article

Perioperative Management of Spinal Arteriovenous Malformation Embolization: Delayed Venous Thrombosis and Implications for Severe Back Pain

Authors: Bikei Ryu, Tatsuki Mochizuki, Shogo Shima, Shinsuke Sato, Tatsuya Inoue, Takakazu Kawamata, Yasunari Niimi

Abstract

Background and Purpose

The prognosis of untreated spinal arteriovenous malformations (SAVMs) is poor. Embolization plays an important role in the management of intramedullary SAVMs. Delayed aggravation due to spinal venous thrombosis following successful embolization has been reported; however, perioperative management strategies to prevent thrombosis have not been explored. We present our single-center experience of SAVM embolization and perioperative management, including anticoagulation.

Material and Methods

We retrospectively evaluated 18 patients with SAVMs who underwent transarterial embolization. Perioperative anticoagulation therapy was administered to selected patients. We compared the characteristics of the patients, including perioperative management procedures, between those with and without postoperative worsening following embolization.

Results

Acute postoperative worsening within 1 week occurred in 4 (22.2%) patients. Of these, immediate worsening was observed in one patient as a procedure-related complication. Delayed worsening after 24 h was observed in 3 patients, caused by delayed venous thrombosis with severe back pain. Rescue anticoagulation for delayed worsening improved symptoms in two patients. A comparison between patients with and without acute postoperative worsening revealed significant differences in age (median 46.5 vs. 26.5 years, p = 0.009) and the presence of postoperative back pain (75.0% vs. 0%, p = 0.005); however, there was no significant difference in use of selective anticoagulation (p = 0.274).

Conclusion

The results of this study suggest that SAVM embolization can cause acute worsening due to postoperative venous thrombosis with severe back pain, which may be reversed by anticoagulation therapy. Back pain is an important finding that suggests venous thrombosis, and anticoagulation should be urgently administered.

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Title: Perioperative Management of Spinal Arteriovenous Malformation Embolization: Delayed Venous Thrombosis and Implications for Severe Back Pain
Authors: Bikei Ryu
Tatsuki Mochizuki
Shogo Shima
Shinsuke Sato
Tatsuya Inoue
Takakazu Kawamata
Yasunari Niimi
Publication date: 09-04-2024
Publisher: Springer Berlin Heidelberg
Keywords: Venous Thrombosis
Venous Thrombosis
Back Pain
Back Pain
Back Pain
Arteriovenous Malformation
Thrombosis
Published in: Clinical Neuroradiology
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-024-01403-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perioperative Management of Spinal Arteriovenous Malformation Embolization: Delayed Venous Thrombosis and Implications for Severe Back Pain

Abstract

Background and Purpose

Material and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and Purpose

Material and Methods

Results

Conclusion

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