New Treatment Approaches to Arteriovenous Malformations

Gilbert, Patricia; Dubois, Josée; Giroux, Marie; Soulez, Gilles

doi:10.1055/s-0037-1604299

Cited by 60 publications

(59 citation statements)

References 39 publications

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“…Periinterventional imaging should verify the clinically suspected diagnosis of a vascular anomaly and provide sufficient information for precise treatment planning [12,13]. The goal of this over-view of the essentials in periinterventional imaging of peripheral vascular anomalies is to simplify the diagnostic approach and the interdisciplinary management of this rare disease.…”

Section: Introductionmentioning

confidence: 99%

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Sadick

Overhoff

Baeßler

et al. 2019

Fortschr Röntgenstr

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Background Peripheral vascular anomalies represent a rare disease with an underlying congenital mesenchymal and angiogenetic disorder. Vascular anomalies are subdivided into vascular tumors and vascular malformations. Both entities include characteristic features and flow dynamics. Symptoms can occur in infancy and adulthood. Vascular anomalies may be accompanied by characteristic clinical findings which facilitate disease classification. The role of periinterventional imaging is to confirm the clinically suspected diagnosis, taking into account the extent and location of the vascular anomaly for the purpose of treatment planning. Method In accordance with the International Society for the Study of Vascular Anomalies (ISSVA), vascular anomalies are mainly categorized as slow-flow and fast-flow lesions. Based on the diagnosis and flow dynamics of the vascular anomaly, the recommended periinterventional imaging is described, ranging from ultrasonography and plain radiography to dedicated ultrafast CT and MRI protocols, percutaneous phlebography and transcatheter angiography. Each vascular anomaly requires dedicated imaging. Differentiation between slow-flow and fast-flow vascular anomalies facilitates selection of the appropriate imaging modality or a combination of diagnostic tools. Results Slow-flow congenital vascular anomalies mainly include venous and lymphatic or combined malformations. Ultrasound and MRI and especially MR-venography are essential for periinterventional imaging. Arteriovenous malformations are fast-flow vascular anomalies. They should be imaged with dedicated MR protocols, especially when extensive. CT with 4D perfusion imaging as well as time-resolved 3D MR-A allow multiplanar perfusion-based assessment of the multiple arterial inflow and venous drainage vessels of arterio-venous malformations. These imaging tools should be subject to intervention planning, as they can reduce procedure time significantly. Fast-flow vascular tumors like hemangiomas should be worked up with ultrasound, including color-coded duplex sonography, MRI and transcatheter angiography in case of a therapeutic approach. In combined malformation syndromes, radiological imaging has to be adapted according to the dominant underlying vessels and their flow dynamics. Conclusion Guide to evaluation of flow dynamics in peripheral vascular anomalies, involving vascular malformations and vascular tumors with the intention to facilitate selection of periinterventional imaging modalities and diagnostic and therapeutic approach to vascular anomalies. Key Points: Citation Format

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Section: Introductionmentioning

confidence: 99%

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Sadick

Overhoff

Baeßler

et al. 2019

Fortschr Röntgenstr

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“…The standard approach to management of congenital arteriovenous malformations is useful and applicable to FFVA in patients with PHTS. 15,16 In the present study, the complexity of angioarchitecture required the use of transarterial, transvenous, and direct percutaneous approaches using several embolic agents and sclerosants during each procedure. 16 The largest and most distal arteriovenous communications were occluded first to improve distal perfusion and to alleviate pain from steal phenomenon.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 In the present study, the complexity of angioarchitecture required the use of transarterial, transvenous, and direct percutaneous approaches using several embolic agents and sclerosants during each procedure. 16 The largest and most distal arteriovenous communications were occluded first to improve distal perfusion and to alleviate pain from steal phenomenon. The dilated ectatic proximal draining veins of FFVA served as a useful target for retrograde 11 or percutaneous transvenous embolization that was performed in three patients resulting in complete resolution of pain.…”

Section: Discussionmentioning

confidence: 99%

Temporal Evolution and Management of Fast Flow Vascular Anomalies in PTEN Hamartoma Tumor Syndrome

et al. 2018

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Phosphatase and tensin homolog (PTEN) hamartoma tumor syndrome (PHTS) is characterized by formation of recurrent benign tumors described as PTEN hamartoma of soft tissue that may contain fast flow vascular anomalies (FFVA). The purpose of this study is to review the temporal evolution and management of FFVA in PHTS. A retrospective review of 22 patients (9 males), age 1 to 18 (median 9) years diagnosed with PHTS at a tertiary care pediatric hospital between October 2002 and August 2017 revealed 4 patients with FFVA. Imaging, management, and treatment complications were reviewed. During median follow-up of 8 (range: 4-13) years, ultrasound and magnetic resonance imaging performed for recurrent pain, showed progressive increase in the size of hamartomas and development of new FFVA in three-fourth patients. Medical management included pain medications, oral sirolimus, and physical and psychiatric therapy. Surgical excision of hamartoma ( = 1) resulted in recurrence within 3 months. Between 4 and 24 (average 1.5/year) embolizations were performed per patient. Pain related to FFVA responded well to embolization. Pain secondary to PTEN hamartoma responded poorly to percutaneous sclerosant injection, but demonstrated improvement with sirolimus. There was no correlation between serum sirolimus levels and frequency/timing of recurrence of FFVA/hamartoma. Complications included sclerosant migration into digital arteries ( = 1), subclavian vein stenosis due to glue migration ( = 1), oral mucositis ( = 4), and elevated triglycerides ( = 4). Patients with PHTS present with recurrent pain requiring life-long management with a multi-disciplinary team. Pain due to FFVA responds to embolization, and pain due to hamartoma responds to sirolimus. This improves quality of life, but does not prevent disease progression.

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“…Subsequent arteriography is considered essential before proceeding with treatment in order to precisely evaluate feeding arteries and draining veins although in this case, angiography was not therapeutic. 5 …”

Section: Discussionmentioning

confidence: 99%

Management of symptomatic adult penile urethral arteriovenous malformation

Houston

Raghavan

Asghar

et al. 2021

Urology Case Reports

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We present the Case of a 23-year-old male with a history of recurrent spontaneous urethral bleeding due to an arteriovenous malformation (AVM) of his corpus spongiosum which abutted his penile urethra. AVMs are often congenital but can also be related to prior trauma. The literature on male genital AVMs is primarily limited to pediatric AVMs of the scrotum or glans penis with one report of adult urethral AVM in the setting of known trauma. We describe a novel presentation of atraumatic adult male genital AVM treated by surgical repair with resolution of bleeding.

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New Treatment Approaches to Arteriovenous Malformations

Cited by 60 publications

References 39 publications

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Temporal Evolution and Management of Fast Flow Vascular Anomalies in PTEN Hamartoma Tumor Syndrome

Management of symptomatic adult penile urethral arteriovenous malformation

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