Peripheral arteriovenous malformations: Vascular and endovascular surgical therapeutic modalities


AKÇALI Y. F.

8th International Congress of Update in Cardiology and Cardiovascular Surgery, Turkey, 1 - 04 December 2008, pp.45

  • Publication Type: Conference Paper / Summary Text
  • Country: Turkey
  • Page Numbers: pp.45

Abstract

Background. Arteriovenous malformations (AVMs) are rare vascular malformations with direct communications between arteries and veins. They bypass capillary bed creating a nidus. Patients and method. Eighteen patients (6 female and 12 male) with AVM were followed and treated between 2000 and 2008. Their median age was 19 years (range, 2 months and 37 years). These patients accounted for 16.0 per cent of the patients with all congenital vascular malformations (CVMs) managed and/or followed during the same period. Cranial AVMs (n=8) in this period were excluded from the present study. AVMs were in locations of cervico-facial (n=3) and extremity (upper: n=2, right; lower: n=13, eight of them in the left). AVMs were at birth in 66.6% of the cases. According to Schobinger’s clinical staging, %5.5 of the patients was Stage 1 (dormant), %55.5, Stage 2 (expansion), and %39, Stage 3 (destruction) (Figure 1). A patient had Klippel-Trénaunay-Weber syndrome associated with AVM (Figure 2). Diagnostic tools were duplex ultrasound (DUS), Computed tomographic angiography (CTA), magnetic resonance imaging/ angiography (MRI/MRA), and digital subtraction angiography (DSA) (Figure 3). Postoperative status was evaluated by DUS. Results. Seven patients were treated by only coil/NBCA embolization, and 6 patients were treated by surgery with (n=2) or without pre-embolization (Figure 4-7). In a patient, ‘glue-embolothrombectomy’ was performed for acute limb ischemia developing after embolization. After embolotherapy, recurrence developed in two patients with limb AVM. One of them was asymptomatic a year after embolization, whereas the other was symptomatic two years after. Re-embolization was performed to symptomatic patient. There was no mortality or major morbidity in the postoperative period. Three patients who refused the proposed therapy had AVMs in their hands (n=2, one of them was Stage 3), foot (n=1, Stage 3), and thigh (n=1, Stage 1). They are still being followed-up on an outpatient basis. Conclusion. Peripheral arteriovenous malformations are therapeutically challenging and rare pathologic entities. The therapeutic procedures of choice are either embolotherapy, which can require multi-session and should aim to eradicate the nidus completely, or surgical resection with/without embolization for the patients with significant symptomatology. Patients’ education regarding the complex nature of AVM and the need for repeated treatment is crucial.