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Published on: April 26, 2019
Congenital vascular malformations in the hand and forearm
C T Sofocleous1, R J Rosen, K Raskin
1Department of Radiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark 07013, USA. constant@pol.net
Insights
Embolotherapy is a safe and effective treatment for rare congenital vascular malformations of the hand and forearm. This approach, often combined with surgery, offers high success rates and symptom relief for patients with arteriovenous malformations (AVM) and primary venous malformations (PVM).
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Pediatric Surgery
Background:
- Congenital vascular malformations (CVMs) of the hand and forearm are rare and complex conditions.
- Effective management requires a thorough understanding of lesion type, including high-flow arteriovenous malformations (AVM) and low-flow primary venous malformations (PVM).
- A multidisciplinary approach is crucial for optimal diagnosis and treatment planning.
Purpose of the Study:
- To review a single-center's experience in managing symptomatic CVMs of the hand and forearm.
- To evaluate the efficacy and safety of embolotherapy as a primary or adjunctive treatment modality.
- To assess outcomes for different types of vascular malformations, specifically AVMs and PVMs.
Main Methods:
- Retrospective chart review of patients with symptomatic CVMs of the hand and forearm treated between 1983 and 1998.
- Diagnostic arteriography and venography to differentiate between AVMs and PVMs.
- Analysis of clinical data, procedural results, and long-term follow-up outcomes.
Main Results:
- Thirty-nine patients with symptomatic CVMs (21 AVMs, 17 PVMs) were identified.
- Percutaneous embolotherapy achieved immediate technical success in 91% of treated lesions (31/34).
- Long-term follow-up (up to 5 years) showed symptom-free periods averaging 30 months for both AVM and PVM patients, with minimal major complications.
Conclusions:
- Congenital vascular malformations of the hand and forearm are rare and necessitate a multidisciplinary management strategy.
- Microembolotherapy, alone or combined with surgery, represents a safe and highly successful treatment option.
- The study highlights the effectiveness of embolization in achieving long-term symptom control for these challenging lesions.
Purpose:
To review a single-center experience in the management of symptomatic congenital vascular malformations of the hand and forearm with special attention to embolotherapy.
Methods:
A retrospective chart review was performed to identify patients with vascular malformations referred for arteriography and possible intervention between 1983 and 1998. Arteriography and venography were performed in all patients to differentiate between true high-flow arteriovenous malformations (AVM) and low-flow primary venous malformations (PVM). The clinical and radiological data, procedural results, and follow-up data were retrieved and reviewed.
Results:
In a 15-year period, 39 patients (22 men; mean age 22.5 years, range 1-51) had symptomatic vascular lesions diagnosed in the forearm and hand: 21 AVMs, 17 PVMs, and one complex lesion with both AVM and PVM. Thirty-four (87%) lesions were treated with immediate technical success achieved in 31 (91%) cases; 5 (13%) lesions were not amenable to percutaneous treatment. There were no major complications, but 3 embolized AVMs had significant residual flow (81.6% technical success on intention to treat basis). Long-term follow-up ranging to 5 years was available in 26 of the 34 treated patients; the mean symptom-free period was 30 months for the AVM patients and 30.5 months for the PVM group, with an average of 1.5 and 1.2 embolization procedures, respectively.
Conclusions:
Vascular malformations of the hand and forearm are extremely rare lesions that demand a multidisciplinary approach for optimal diagnosis and management. Microembolotherapy with or without surgery has offered the highest level of safety and success to date.
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