Novel classification for simple peripheral arteriovenous malformations based on anatomic localization: Prevalence data from the tertiary referral center in China

Abstract

BackgroundIn absence of the large-sample study of simple peripheral arteriovenous malfomations (pAVM), we aimed to perform the epidemiological analysis of over 1,000 simple pAVM patients from our center in the past 5 years, and establish a novel classification based on the anatomical localization of the primary lesion.ResultsBetween March 27, 2016, and March 31, 2021, Chinese patients who were diagnosed with simple pAVM were taken into account. Those who suffered from simple arteriovenous malformations of the central nervous system (cnsAVM), combined types of AVM, and syndromes, such as CLOVES syndrome, etc. were all excluded from this study. A total of 1,070 simple pAVM patients were screened out. All of the simple pAVM patients were diagnosed by clinical manifestations and imaging examinations. Demographic data were obtained from the National Bureau of Statistics of China. The 5-year prevalence of simple pAVM was about (2.15–6.60) /1,000,000 population. The male-female ratio was approximately 1.22:1. The pAVM inpatients that were included in the age group of 21~30 years old had the highest constituent ratio (P = 0.01). The classification included four groups: Type I (primarily occurring in soft tissue); Type II (primarily occurring in bone); Type III (primarily occurring in the viscus) and Type IV (simple pAVM coexisting with CNS lesions). There were two subtypes of Type I: the A subtype (involving one major anatomical region) and the B subtype (involving two or more major anatomical regions); two subtypes of Type II: the A subtype (the cortex was intact) and the B subtype (the lesion had broken through the cortex). Generally, 657 patients were classified as Type IA (61.4%), 232 patients were Type IB (21.7%), 82 patients were Type IIA (7.7%) and 79 were categorized as Type IIB (7.4%); the number of patients who had Type III and Type IV pAVM were 9 (0.8%) and 11 (1.0%), respectively. The clinical manifestations and diagnostic standards for each type were also systematically summarized.ConclusionsPrevalence data for simple pAVM were analyzed, and a novel classification was proposed based on the anatomy of the lesions. The present work was expected to facilitate the diagnosis of simple pAVM in clinical works.

Ethanol embolization of arteriovenous malformations in the buttock: ten-year experiences in diagnoses and treatment options

“…Peripheral AVMs are complex lesions and can be very aggressive locally. They can cross tissue boundaries and even penetrate cortical bone [ 1 ]. Endovascular embolization is particularly effective when treating peripheral AVMs, especially when done using the guidance of the Yakes classification.…”

“…Arteriovenous malformations (AVMs) are congenital diseases that usually appear in an insidious form at birth and are easily overlooked during childhood [ 1 ]. Several factors, including trauma, infection, and hormonal changes, lead to the expansion and deterioration of the AVMs lesions [ 2 ].…”

“…Peripheral AVMs have a low prevalence rate, approximately (2.15–6.60) /1,000,000 population, whereas AVMs in the buttock (bAVMs) are even rarer, and their treatment is challenging [ 1 ]. Symptoms of bAVMs vary from asymptomatic erythema to a potentially life-threatening hemorrhage and even impaired mobility, causing severe functional disorders [ 3 ].…”

A rare case of Bannayan-Riley-Ruvalcaba syndrome with concurrent arteriovenous malformation

“… 32 Because our patient remained asymptomatic, conservative treatment with annual follow-up visits and imaging surveillance was offered based on the current literature. 33 If AVMs progress to become symptomatic and disabling, endovascular embolization or surgical resection could be considered. Until further research is reported, we suggest conservative therapy, including compression and elevation, for asymptomatic patients with AVMs, reserving endovascular or surgical intervention for patients with severe symptoms affecting their daily living activities.…”

Overview of peripheral arteriovenous malformations: From diagnosis to treatment methods

“… 12 Moreover, when patients with head and neck AVMs turn their heads toward the healthy side, external jugular vein dilatation can be observed on the affected side. 10 Other indicators of patients with AVMs include tortuous and dilated outflow veins, as well as relatively typical local manifestations upon physical examination, including bleeding, ulcers, and infections caused by skin and mucosal ischemia, particularly in patients with acral AVMs. 13 In the later stages of this disease, patients may exhibit decompensated presentations, such as congestive heart failure involving palpitations, shortness of breath, and chest tightness symptoms, owing to long-term increased venous return.…”