Endovascular treatment results and risk factors for complications of body and extremity arteriovenous malformations

Park, Kwang Bo; Soo, Young; Kim, Dong Ik; Kim, Young‐Wook; Park, Hong Suk; Shin, Sung Wook; Cho, Sung Ki; Hyun, Dongho; Choo, Sung Wook

doi:10.1016/j.jvs.2018.07.051

Cited by 28 publications

(26 citation statements)

References 26 publications

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“…Although the angiographic classification system provided distinguishable categories for the AVMs, not all of them completely fall into the six specified types. Twenty-seven percent of AVMs are classified as complex, as they belong to different categories at the same time (9). Based on the angiographic classification, patients with type I and type II AVMs showed the best clinical results after ethanol embolotherapy with or without coils; those with type IIIb AVMs showed satisfactory outcomes.…”

Section: Treatment Resultsmentioning

confidence: 99%

“…The interval between sessions is generally 3 months to 6 months, depending on patient symptoms or the extent of AVMs. Park et al (9) reported that with experience, the number of treatment sessions can be reduced to almost half (4.2 sessions in the first decade and 2.3 sessions in the last decade), and treatment failure can be reduced significantly from 9.4% within the first decade to 1.5% within the last decade. This outcome may be attributed to the growing knowledge of AVM hemodynamics and the modifications of the treatment technique based on the angiographic types of AVMs (9).…”

Section: Treatment Resultsmentioning

confidence: 99%

“…However, an intra-arterial ethanol injection is prone to creating skin complications because tiny angiographically invisible normal arteries become exposed to ethanol. Direct puncturing of the dilated fistula and injecting ethanol were proven to be effective, and they induced fewer skin complications (9). Since the initiation of endovascular therapy for AVMs, ethanol has been the preferred embolic agent because of its strong devascularization effect resulting from endothelial damage of the vessel, serum protein denaturation, and A.…”

Section: A B Cmentioning

confidence: 99%

“…In recent decades, extensive experience has been accumulated in the treatment of AVMs, which covers the angiographic classification of AVMs, approaches, embolization materials, and treatment results. The new angiographic classification of AVMs, proposed by Do et al, (4,8) kjronline.org and outcomes (4,(7)(8)(9). In this article, the angiographic classification and endovascular treatment of peripheral AVMs will be described.…”

Section: Introductionmentioning

confidence: 95%

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How to Treat Peripheral Arteriovenous Malformations

2021

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Arteriovenous malformations (AVMs) are direct communications between primitive reticular networks of dysplastic vessels that have failed to mature into capillary vessels. Based on angiographic findings, peripheral AVMs can be classified into six types: type I, type IIa, type IIb, type IIc, type IIIa, and type IIIb. Treatment strategies vary with the types. Type I is treated by embolizing the fistula between the artery and the vein with coils. Type II (IIa, IIb, and IIc) AVM is treated as follows: first, reduce the blood flow velocity in the venous segment of the AVM with coils; second, perform ethanol embolotherapy of the residual shunts. Type IIIa is treated by transarterial catheterization of the feeding arteries and injection of diluted ethanol. Type IIIb is treated by transarterial or direct puncture approaches. A high concentration of ethanol is injected through the transarterial catheter or direct puncture needle. When the fistula is large, coil insertion is required to reduce the amount of ethanol. Type I and type II AVMs showed the best clinical results; type IIIb showed a satisfactory response rate. However, type IIIa showed the poorest response rate, either alone or in combination with other types. Clinical success can be achieved by using different treatment strategies for different angiographic AVM types.

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Section: Treatment Resultsmentioning

confidence: 99%

Section: Treatment Resultsmentioning

confidence: 99%

Section: A B Cmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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How to Treat Peripheral Arteriovenous Malformations

2021

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“…Therefore, diluted ethanol has been used to reduce complication rate and ethanol dose 11 . It is also often reported that sclerotherapy with STS carries lower toxicity than ethanol 1 13-15 21 .…”

Section: Lower Extremity Vascular Malformationsmentioning

confidence: 99%

Incidence of major complication following embolo-sclerotherapy for upper and lower extremity vascular malformations

et al. 2020

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Objective The current literature on the major complications of embolo-sclerotherapy of upper and lower extremity vascular malformations is scarce. Evaluating and understanding the rates and types of potential major complications of embolo-sclerotherapy of vascular malformations help treatment planning and informed consent. Therefore, this study reviewed major complications following embolo-sclerotherapy of all upper and lower extremity vascular malformations in a single specialized multidisciplinary vascular malformation center over a 5-year period. Methods All patients with vascular malformations underwent multidisciplinary directed intervention. Demographic, procedural, follow-up, and complication data were collected prospectively in a dedicated database, and reviewed retrospectively. Major complications for upper and lower extremity vascular malformations from 1 January 2013 to 31 December 2017 were analyzed. All embolo-sclerotherapies of high-flow vascular malformations (HFVMs) were performed under selective catheter angiography and direct injection, but low-flow vascular malformations (LFVM) with direct injection only. Major complications were defined as any tissue or functional damage caused by direct injection, distal embolization, or tissue reaction. Results Seventy patients (median age of 25 years; 44 males and 26 females) had 150 embolo-sclerotherapy procedures for upper extremity vascular malformation. Of these, 28 patients had embolo-sclerotherapy for HFVM and 42 patients for LFVM; total 78 and 72 procedures, respectively. A total of 107 patients (median age of 26 years; 42 males and 65 females) had 160 embolo-sclerotherapy interventions for lower extremity vascular malformations. Of these, 18 patients had embolo-sclerotherapy for HFVM and 89 patients for LFVM; total of 30 and 130 procedures, respectively. The overall major complication rates following embolo-sclerotherapy of upper and lower extremity vascular malformations were 14.3% and 4.7%, respectively ( P = 0.030). In the upper extremity HFVM group, major complications from embolo-sclerotherapy occurred in five patients; three ischemic fingers requiring amputation and two skin ulcerations. Meanwhile, in the upper extremity LFVM group, major complications occurred in five patients; one median nerve injury requiring nerve grafting and hand therapy, one hand contracture requiring tendon release, and three skin ulcerations. There was only one major complication, which was cellulitis in the lower extremity HFVM group. In the lower extremity LFVM group, major complications occurred in four patients; two skin ulcerations, one cellulitis, and one deep vein thrombosis. Conclusions Embolo-sclerotherapy is relatively safe for upper and lower extremity vascular malformations in a high-volume experienced center where our major complication rates were 14.3% and 4.7%, respectively, which compare favorably or similar to those reported in most recent literature. These outcomes will direct treatment strategies to avoid local and systemic toxic complications in the upper and lower extremity, for both HFVM and LFVM, and to improve informed consent.

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Behandlungsverfahren bei vaskulären Malformationen

Clemens¹,

Wohlgemuth²

2022

Klinische Angiologie

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Endovascular treatment results and risk factors for complications of body and extremity arteriovenous malformations

Cited by 28 publications

References 26 publications

How to Treat Peripheral Arteriovenous Malformations

How to Treat Peripheral Arteriovenous Malformations

Incidence of major complication following embolo-sclerotherapy for upper and lower extremity vascular malformations

Behandlungsverfahren bei vaskulären Malformationen

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