Extremity Arteriovenous Malformations Involving the Bone: Therapeutic Outcomes of Ethanol Embolotherapy

Head and Neck Arteriovenous Malformations: Results of Ethanol Sclerotherapy

“…The most important factors in assessing the usability of any treatment method for peripheral AVM are its success in complete nidus eradication, complication rate, and long-term recurrence rate. Reports on ethanol sclerotherapy of trunk and extremity AVMs have shown potential for total nidus ablation [10][11][12][13][14][15][16] ; success is, however, less for lesions in delicate locations such as the hand and fingers. 16 The diagnosis "AVM" possibly includes subsets with diverse biologic behavior, and lesion angioarchitecture may predict response to treatments.…”

“…Although most complications from ethanol sclerotherapy heal without long-standing functional damage, a serious risk remains for permanent or major complications, reported at 0%-26% frequency per patient. [10][11][12][13][14][15][16][17][18][19][20] Direct interpretation of these figures is difficult because classification of complications between series differs. For example, some include in major complications any event that requires hospitalization for Ͼ48 hours, including those that resolve completely with or without treatment, 14 while others may record as major complications only events that leave a per-manent disturbance.…”

“…29 The most common complication of ethanol sclerotherapy is local skin or mucosal surface necrosis. [10][11][12][13][14][15][16][17][18][19][20] 37 Other possible systemic effects of ethanol include intravascular hemolysis 38 and bronchospasm. 39 Our complication rate was in line with rates in other studies.…”

“…39 Our complication rate was in line with rates in other studies. [10][11][12][13][14][15][16][17][18][19][20] All permanently visible complications included scarring after skin necrosis (n ϭ 5) and local loss of cutaneous hair (n ϭ 2). In retrospect, 3 of our skin/mucosal complications (1 in an upper lip, 1 in a lower eyelid, 1 in a scalp) probably resulted from an injection not sufficiently selective during treatment of a superficial AVM and might have been avoidable.…”

“…Absolute ethanol differs from other liquid embolics, being a toxic substance that permanently destroys the endothelial cells and the vessel wall, 9 and careful nidus ablation with endovascular ethanol (ethanol sclerotherapy) has potential for angiographic eradication of extracranial AVMs. [10][11][12][13][14][15][16] Empirical evidence concerning whether ethanol sclerotherapy can offer more lasting long-term results than careful embolization with other liquid agents is, however, lacking. Further, the complication risk due to its toxic nature warrants caution.…”