Diagnostic Methods, Treatment Modalities, and Follow-up of Extracranial Arteriovenous Malformations

Abstract

Objective. Arteriovenous malformations (AVMs) are an uncommon vascular pathology that remains challenging to accurately diagnose and successfully treat. This study introduces a novel way to evaluate AVM treatment outcomes using transarterial lung perfusion scintigraphy (TLPS) and reports our treatment results. Material and Methods. The patients treated for extracranial AVMs were studied retrospectively. Diagnosis and outcomes were based on clinical data, ultrasonography, magnetic resonance imaging, computed tomography, angiography, and TLPS studies. The influence of gender; location, form, and stage of AVMs; first attempt at treatment; and treatment modalities was analyzed. Outcomes were defined as positive (cure, improvement, and remission) or negative (no remission and aggravation). Results. Of the 324 patients with congenital vascular malformations, 129 (39.8%) presented with AVMs, and the data of 56 treated patients with AVMs were analyzed. Of the 29 patients in the endovascularly treated group, 15 in the surgically treated group, and 12 in the combined treatment group, 24 (82.8%), 14 (93.3%), and 10 patients (83.3%), respectively, had positive outcomes (P>0.05). All outcomes were positive in surgically treated patients with extratruncular limited AVMs, and these patients were more likely to be cured as compared with those who had other forms of AVMs (OR, 5.8; 95% CI, 1.1–29; P=0.02). The patients with more advanced AVMs (stages III and IV) and with AVMs in the gluteal and pelvic region were more likely to have the worst outcomes than those with stage II AVMs (OR, 8.2; 95% CI, 1–72; P=0.03) and with AVMS in other locations (OR, 5.8; 95% CI, 1.1–29; P=0.02), respectively. Gender and age did not significantly influence treatment results (P>0.05). The TLPS data of 17 patients showed AV shunting ranging from 0% to 92%, which combined with other results helped identify 9 patients who needed further interventions, 6 who were treated successfully, and 2 who had insignificant shunting. Conclusions. The best outcomes were achieved in surgically treated patients with localized lesions and less advanced AVMs. For the first time in Lithuania, a modified TLPS method has been introduced that enhances a hemodynamic assessment of AV shunting and provides with a more accurate evaluation of AVMs to better serve in planning future treatments.

Thermographic Assessment of a Vascular Malformation of the Hand: A New Imaging Modality

“…AVMs can be located in various anatomic areas and sometimes occur simultaneously in several regions. In a study by Vaišnyte et al ., extracranial AVMs were analyzed, of which 80.4% were located in the extremities and the gluteal region,[ 10 ] allowing easy access for thermal imaging. At present, progression of AVMs is monitored clinically with impairment of function or pain determining the management.…”

Extracranial arteriovenous malformations in children: features of clinical course, diagnosis and treatment

“…Значний руйнівний потенціал АВМ мають внаслідок складної гемодина-міки, що забезпечується наступними властивостями: швидкий рух крові в ділянці ураження, венозна гіпер-тензія дистальніше від вогнища, прогресуючий пере-біг захворювання і здатність до проліферації, наяв-ність «гнізда» з комунікантами різного діаметра [17].…”

“…Клінічні прояви та ускладнення АВМ багато в чому залежать від того, які органи і тканини уражені [17]. У нашому дослідженні клінічними проявами АВМ у ділянці обличчя були зміни кольору шкіри, асиме-трія обличчя за рахунок пухлиноподібного утворення, кровотеча, виразки.…”

Venous malformation and haemangioma: differential diagnosis, diagnosis, natural history and consequences

“…This study also assesses the extent of shunting of cardiac output through the AVM lesion when located in an extremity. 53,54…”