Efficacy of embolo/sclerotherapy in the treatment of high-output cardiac failure caused by peripheral arteriovenous malformations

Purpose This study aimed to evaluate the effectiveness and outcomes of embolo/sclerotherapy in treating Schobinger Stage IV peripheral arteriovenous malformations (pAVMs) associated with high-output cardiac failure (HOCF). Methods Between January 2017 and December 2024, 12 patients with Schobinger Stage IV pAVMs and associated HOCF were treated with embolization using coils and sclerosing agents, including bleomycin polidocanol foam (BPF) and anhydrous ethanol. Procedural outcomes, complications, devascularization and improvements in cardiac function were evaluated during follow-up. Results A total of 24 embolo/sclerotherapy sessions were performed on the 12 patients. Complete or over 80% devascularization of the vascular malformations was achieved in 9 patients. Echocardiographic follow-up revealed significant improvements in cardiac ejection fraction and ventricular dilatation. Additionally, 8 patients showed improvement in heart valve regurgitation. For all patients, the symptom of dyspnea disappeared after embolization and no serious complications occurred. LVEF improvement showed a significant positive correlation with a decrease in venous drainage pressure of the nidus after surgery ( P < 0.001) in 11 patients, while one patient was excluded due to an increase in venous drainage post-surgery. Conclusion This study provides evidence that embolo/sclerotherapy effectively treats pAVMs with associated HOCF by reducing abnormal blood flow and significantly improving symptoms. The results also reveal a linear relationship between the decrease in venous drainage pressure and improvement in LVEF in patients with HOCF caused by pAVMs after embolo/sclerotherapy.