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Treatment Outcomes of Embolization for Peripheral Arteriovenous Malformations

To evaluate treatment outcomes of embolization for peripheral arteriovenous malformations (AVMs) in a tertiary referral center where ethanol is the primary agent of choice.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.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.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.
- Boston Children's Hospital United States
- Radboud University Nijmegen Netherlands
- Boston Children's Hospital United States
Adult, Male, Adolescent, Dermatology - Radboud University Medical Center, Arteriovenous Malformations, Young Adult, Radboudumc 16: Vascular damage RIHS: Radboud Institute for Health Sciences, Risk Factors, Medical Imaging - Radboud University Medical Center, Humans, Child, Aged, Retrospective Studies, Radboudumc 10: Reconstructive and regenerative medicine RIMLS: Radboud Institute for Molecular Life Sciences, Ethanol, Middle Aged, Embolization, Therapeutic, Treatment Outcome, Child, Preschool, Female, Radboudumc 0: Other Research RIHS: Radboud Institute for Health Sciences, Radboudumc 10: Reconstructive and regenerative medicine RIHS: Radboud Institute for Health Sciences, Surgery - Radboud University Medical Center
Adult, Male, Adolescent, Dermatology - Radboud University Medical Center, Arteriovenous Malformations, Young Adult, Radboudumc 16: Vascular damage RIHS: Radboud Institute for Health Sciences, Risk Factors, Medical Imaging - Radboud University Medical Center, Humans, Child, Aged, Retrospective Studies, Radboudumc 10: Reconstructive and regenerative medicine RIMLS: Radboud Institute for Molecular Life Sciences, Ethanol, Middle Aged, Embolization, Therapeutic, Treatment Outcome, Child, Preschool, Female, Radboudumc 0: Other Research RIHS: Radboud Institute for Health Sciences, Radboudumc 10: Reconstructive and regenerative medicine RIHS: Radboud Institute for Health Sciences, Surgery - Radboud University Medical Center
citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).24 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Top 10% influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Top 10% impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Top 10%
