Frédérique C M Bouwman1, Sanne M B I Botden2, Bas H Verhoeven2, Leo J Schultze Kool3, Carine J M van der Vleuten4, Ivo de Blaauw2, Willemijn M Klein3. 1. Department of Radiology and Nuclear Medicine, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands; Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, Netherlands. Electronic address: Frederique.Bouwman@radboudumc.nl. 2. Department of Surgery, Division of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Nijmegen, Netherlands. 3. Department of Radiology and Nuclear Medicine, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands. 4. Department of Dermatology, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands.
Abstract
PURPOSE: To evaluate treatment outcomes of embolization for peripheral arteriovenous malformations (AVMs) in a tertiary referral center where ethanol is the primary agent of choice. METHODS: A retrospective study was performed of 93 patients (median age, 31 years; range, 2-66 years) with peripheral AVMs treated with embolization (n = 442; median, 2 per patient; range, 1-82) between January 2010 and July 2016. Ethanol was used in most cases (n = 428; 97%). AVMs were classified as type I (n = 3), type II (n = 57), type IIIa (n = 5), type IIIb (n = 15), and type IV (n = 13) according to the Yakes classification system. Effectiveness of embolization was based on AVM devascularization on angiography: 100% (total), 90%-99% (near-total), 70%-90% (substantial), 30%-70% (partial), and 0%-30% (failure). Complications were graded according to the Society of Interventional Radiology classification. RESULTS: In 69% of patients, 70%-100% devascularization was achieved. Total and near-total occlusion of the nidus were more often achieved in AVMs of types I and IIIa (both 100%) than in AVMs of types II, IIIb, and IV (56%, 67%, and 39%, respectively; P = .019). A total of 109 complications were identified: 101 minor (22.9%) and 8 major (1.8%). Major complications included wounds (n = 5), false aneurysm (n = 1), finger contracture (n = 1), and severe pain (n = 1) requiring therapy. The patient complication risk was significantly affected by the number of procedures (relative risk = 2.0; P < .001). Age, AVM location, and angioarchitecture type did not significantly affect complication risk. CONCLUSIONS: AVM embolization resulted in 70%-100% devascularization in 69% of patients, with few major complications. This study indicates that the type of AVM angioarchitecture affects the number of procedures needed and the achievability of AVM devascularization.
PURPOSE: To evaluate treatment outcomes of embolization for peripheral arteriovenous malformations (AVMs) in a tertiary referral center where ethanol is the primary agent of choice. METHODS: A retrospective study was performed of 93 patients (median age, 31 years; range, 2-66 years) with peripheral AVMs treated with embolization (n = 442; median, 2 per patient; range, 1-82) between January 2010 and July 2016. Ethanol was used in most cases (n = 428; 97%). AVMs were classified as type I (n = 3), type II (n = 57), type IIIa (n = 5), type IIIb (n = 15), and type IV (n = 13) according to the Yakes classification system. Effectiveness of embolization was based on AVM devascularization on angiography: 100% (total), 90%-99% (near-total), 70%-90% (substantial), 30%-70% (partial), and 0%-30% (failure). Complications were graded according to the Society of Interventional Radiology classification. RESULTS: In 69% of patients, 70%-100% devascularization was achieved. Total and near-total occlusion of the nidus were more often achieved in AVMs of types I and IIIa (both 100%) than in AVMs of types II, IIIb, and IV (56%, 67%, and 39%, respectively; P = .019). A total of 109 complications were identified: 101 minor (22.9%) and 8 major (1.8%). Major complications included wounds (n = 5), false aneurysm (n = 1), finger contracture (n = 1), and severe pain (n = 1) requiring therapy. The patient complication risk was significantly affected by the number of procedures (relative risk = 2.0; P < .001). Age, AVM location, and angioarchitecture type did not significantly affect complication risk. CONCLUSIONS: AVM embolization resulted in 70%-100% devascularization in 69% of patients, with few major complications. This study indicates that the type of AVM angioarchitecture affects the number of procedures needed and the achievability of AVM devascularization.
Authors: Vanessa F Schmidt; Max Masthoff; Richard Brill; Peter B Sporns; Michael Köhler; Victor Schulze-Zachau; Martin Takes; Denis Ehrl; Daniel Puhr-Westerheide; Wolfgang G Kunz; Mwivano Dunstan Shemwetta; Eric M Mbuguje; Azza A Naif; Abizer Sarkar; Jens Ricke; Max Seidensticker; Walter A Wohlgemuth; Moritz Wildgruber Journal: Cardiovasc Intervent Radiol Date: 2022-06-02 Impact factor: 2.797
Authors: Vanessa F Schmidt; Max Masthoff; Veronika Vielsmeier; Caroline T Seebauer; Özlem Cangir; Lutz Meyer; Antje Mükke; Werner Lang; Axel Schmid; Peter B Sporns; Richard Brill; Walter A Wohlgemuth; Natascha Platz Batista da Silva; Max Seidensticker; Regina Schinner; Julia Küppers; Beate Häberle; Frank Haubner; Jens Ricke; Martin Zenker; Melanie A Kimm; Moritz Wildgruber Journal: Cardiovasc Intervent Radiol Date: 2022-10-19 Impact factor: 2.797