Embolization plays a major role in the management of
arteriovenous malformations and fistulae on one hand, and of venous malformations and
cystic lymphangiomas on the other hand. The treatment of arteriovenous fistulae today resorts to a primarily
endovascular technique including the insertion under controlled flow of a releasable balloon or of a metallic coil positioned in the area of the
fistula. Of course, this is possible only if there is a gap between the arterial and venous pathways. When the vessels are in direct contact, surgery must be preferred. In cases of
arteriovenous malformations, embolization currently plays a great role; either it is performed with particles in the immediate
preoperative period, two or three days before surgery, or as a definitive curative treatment with a polymerizing substance applied in situ. The use of flexible microcatheters allows penetrating into most of these
vascular malformations and scattering polymerizing material all over the shunting areas. This is possible for superficial malformations, as is now performed, for instance, for brain AVMs. This embolization obviously can be contemplated only after a decision to treat these malformations has been made, knowing that they may be silent or acquire an uncontrollable evolution potential. This therefore is a collegial decision. As far as venous
hemangiomas and
cystic lymphangiomas are concerned, the greatest basic therapeutic means today is direct
puncture and the in situ injection of a fibrosing substance under angiographic monitoring: the use of
Ethibloc or, failing this, of
absolute alcohol, has dramatically transformed the prognosis of these malformations, for which the surgical difficulties are well known (easy
rupture, blood that often fails to coagulate, life-long progressive evolution).(ABSTRACT TRUNCATED AT 250 WORDS)