Late Recurrence After Angiographic Cure of Pediatric Arteriovenous Malformations Treated by Transvenous Embolization

BACKGROUND AND OBJECTIVES: Pediatric brain arteriovenous malformations (AVMs) have higher recurrence rates than adult lesions, yet the long-term durability of transvenous embolization (TVE) in children remains poorly defined. We therefore evaluated long-term clinical and angiographic outcomes after curative TVE for ruptured pediatric AVMs. METHODS: This multicenter retrospective cohort comprised 12 pediatric patients (older than 18 years) treated with curative TVE from 2012 to 2025. Angiographic cure was defined as complete obliteration on 6-month digital subtraction angiography (DSA). Long-term surveillance included annual MRI/magnetic resonance angiography, with confirmatory DSA if recurrence was suspected. RESULTS: Complete angiographic obliteration was achieved in all patients at 6 months. Over a mean follow-up of 103 ± 39 months, no delayed hemorrhages occurred. Late AVM recurrence was identified in 2 patients (17%) after documented angiographic cure and was detected only on delayed imaging surveillance. One recurrence involved a lesion with previous superficial venous drainage, whereas the other occurred in a lesion with deep venous drainage. Both were successfully retreated endovascularly without added morbidity. CONCLUSION: TVE provides durable hemorrhage control in selected pediatric AVMs; however, late recurrence may still occur despite early angiographic cure. These findings confirm that TVE is no exception to the well-documented late recurrence rate of pediatric AVMs across all treatment modalities, reinforcing that prolonged imaging surveillance is as essential after TVE as after microsurgery or radiosurgery.