All right, our next speaker is Jorge Mendez for transvenous curative embolization of cerebrovascular, I'm sorry, cerebral arteriovenous malformation, prospective cohort study. Good afternoon, everyone. I'm Jorge Mendez, and I'm gonna introduce Limoges' experience with the transvenous approach. We have nothing to disclose. As the evolution of the liquids, non-dehasive liquids such as Onyx, the curative embolization of AVMs is evolving as a treatment strategy, especially in European countries. So as such, this treatment is done by the arterial approach traditionally, but in some instances, we don't have the arterial approach, and we have to use the transvenous approach. So we assessed 40 patients that underwent transvenous embolization in a seven-year period. Those characteristics were assessed, demographics, AVM characteristics, and techniques. So this is a typical case for the transvenous approach, deep AVM that bled before, so we came for a direct jugular puncture and accessed the main draining vein, and we could perform the embolization. Here's the Onyx cast, and this is the final result at six months, so total occlusion of the AVM. As a result, we had 67.5% of ruptured AVMs. We could reach 92.6% of anatomical obliteration, and we got two complications related to the procedure, but without clinical consequences. So this is a table that shows exactly that most of the AVMs represented hemorrhage. Most of them were less than three centimeters, and most of the AVMs comprised especially three and four. So some points to discuss is the evolution of the transvenous approach. From the beginning, we're using very small AVMs. With the experience, we are expanding the technique. This series demonstrate a high rate of complete obliteration with excellent functional outcomes. Even though we are coming through the vein, venous ischemia was a rare complication, and as a conclusion, this technique should be used in cases in which surgery or radiosurgery might not be indicated, and we still need larger clinical series and longer follow-up to assess this technique. Thank you. Thanks. One question. Just a quick question. Did you use any arterial occlusion, balloon, or floor? Yeah, that's a good question. All of this transvenous approach, they are both arterial and venous. So we drop the pressure, and we use a balloon for the arterial side, yes, to reduce nidosing flow. Yes. Right, so. What's that, the two procedure-related complications? Procedure is 5%. So we got two complications in 40 patients, 2%, but without clinical consequences. And what kind of complications? So it's one related to navigation, so subarachnoid hemorrhage, and one venous infarct that the patient recovered at six months follow-up, one venous infarct.

prospective cohort study

transvenous curative embolization

cerebral arteriovenous malformation

AVM

complete obliteration