P070 Navigating the venous route: transvenous embolization for complex arteriovenous malformations

<h3>Introduction</h3> Treating arteriovenous malformations (AVMs) poses challenges when arterial access is difficult. Transvenous embolization offers an alternative, particularly in cases with venous drainage and inaccessible arterial feeders. This case study explores transvenous embolization via the Labbe vein in a patient with a Grade 2 AVM, emphasizing feasibility, safety, and efficacy. <h3>Case Description</h3> A 65-year-old male presented with a left frontoparietal bleed revealing a Grade 2 AVM with Labbe vein drainage and high-flow AVF. Transvenous embolization using Onyx was planned, with induced hypotension. Stereotactic Radiosurgery was ruled out due to hemorrhage risk. Venous pressure cooker usage was not feasible due to Labbe vein stenosis. One Apollo microcatheter was damaged, limiting simultaneous catheter placement. A Marathon microcatheter was utilized, and 1ml Onyx 18 was injected, achieving robust embolic cast formation. <h3>Results</h3> Transvenous embolization via the Labbe vein is a feasible and effective approach for treating AVMs, especially with difficult arterial access. Despite technical limitations, careful catheter manipulation and Onyx injection facilitated successful embolization, emphasizing innovative techniques in overcoming procedural hurdles. Further studies are needed to refine the approach for optimal patient care. <h3>Disclosure of Interest</h3> no.