ABSTRACT
Absolute ethanol (96%–98% dehydrated ethyl alcohol) with or without coiling is by far the most commonly used endovascular ablative technique to treat arteriovenous malformations (AVMs) with curative intention due to its protein denaturing, permanent vessel wall damaging property. Percutaneous or retrograde transvenous coiling preceding embolo-sclerotherapy is effective to reduce the amount of ethanol needed in AVMs where multiple arteries connect to a single enlarged or aneurysmal draining vein. Precise delivery of ethanol to the AVM nidus and multisession therapy are necessary to minimize complications. Pulmonary hypertension is a potentially fatal complication associated with ethanol embolo-sclerotherapy if the recommended dose is exceeded. The most frequent local complications are skin blistering or necrosis and transient nerve palsy. To decrease postembolization swelling and to prevent nerve injuries due to edema, routine use of dexamethasone as well as nonsteroidal anti-inflammatory drugs are useful.
