{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:18:52Z","timestamp":1786979932042,"version":"build-2736575974"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Klinikum der Universit\u00e4t M\u00fcnchen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cardiovasc Intervent Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aims to evaluate and compare safety and clinical outcomes of reversible electroporation with either intravenous (BEST) or intraarterial (BEET) Bleomycin application treating extracranial AVMs unsuitable for conventional approaches defined as fine-fistulous AVMs close to vulnerable anatomical structures (such as skin\/end-arteries) not amenable for embolization or resection due to inappropriate risk\/benefit and\/or therapy-refractory or recurrent lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This is a sub-analysis of the prospective multicenter APOLLON trial (German clinical trial register, DRKS00021019). Clinical and imaging findings were assessed at baseline and 6-month follow-up to evaluate subjective outcome (symptom-free, partial relief, no improvement, clinical progression) and AVM lesion devascularization on MRI (total, 100%; substantial, 76\u201399%; partial, 51\u201375%; slight, 50%; progression). BEST versus BEET was at the discretion of the operator; subgroup outcome comparisons were subsequently performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-one AVM patients received 31 treatments (16\/31 BEST, 51.6%; 15\/31 BEET, 48.4%); the mean number of procedures per patient was 1.5 (\u00b1\u20090.7). Complications occurred after 7\/31 (22.6%) procedures, including 6.4% major complications (delayed wound healing solved by split-skin transplantation, persistant scarring). Subjective outcome revealed partial symptom relief in 13\/21 (61.9%) patients, and 4\/21 (19.0%) patients presented symptom-free. In 4\/21 (19.0%) patients, no improvement or symptom worsening was reported. Imaging revealed complete devascularization in one case (6.3%), substantial (76\u201399%) and partial (51\u201375%) devascularization in 6\/16 (36.5%) patients, respectively, while progression was noted in 3\/16 (18.8%) patients. Comparison of clinical outcomes differed between both approaches, with BEET being superior to BEST (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The combination of reversible electroporation and bleomycin is effective for treatment of AVMs; BEET tends to present superior to BEST regarding patients \u2019  outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00270-025-04178-5","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T15:59:51Z","timestamp":1757692791000},"page":"1632-1637","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Combining Reversible Electroporation and Bleomycin in Treatment of Arteriovenous Malformations"],"prefix":"10.1007","volume":"48","author":[{"given":"Florian","family":"Obereisenbuchner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7067-2203","authenticated-orcid":false,"given":"Vanessa F.","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantin","family":"Goldann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Brill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Puhr-Westerheide","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Borisch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Haehl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Hartel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beate","family":"H\u00e4berle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Ricke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Seidensticker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie A.","family":"Kimm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Wildgruber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter A.","family":"Wohlgemuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"issue":"2","key":"4178_CR1","doi-asserted-by":"publisher","first-page":"141","DOI":"10.2478\/raon-2023-0029","volume":"57","author":"T Muir","year":"2023","unstructured":"Muir T, Bertino G, Groselj A, Ratnam L, Kis E, Odili J, et al. 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The remaining authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval for this study was received by institutional review board at LMU University Hospital (protocol no. 20\u2013445).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Consent for publication was obtained for every individual person\u2019s data included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Written consent was obtained from all enrolled patients.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}