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Peripheral high-flow arteriovenous vascular malformations: a single-center experience
Kong T Tan1, Martin E Simons, Dheeraj K Rajan
1Division of Interventional Radiology, Medical Imaging Department, University Health Network, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada. kongtengtan@hotmail.com
Journal of Vascular and Interventional Radiology : JVIR
|October 7, 2004
Summary
High-flow arteriovenous malformations (HFAVMs) of the extremities are rare. Conservative management is effective for mild symptoms, while embolization for severe symptoms requires multiple sessions and carries risks.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Medical Imaging
Background:
- High-flow arteriovenous malformations (HFAVMs) represent a rare and complex vascular condition affecting the extremities.
- These malformations pose significant therapeutic challenges due to their intricate anatomy and high flow dynamics.
Purpose of the Study:
- To evaluate the long-term clinical outcomes for patients diagnosed with high-flow arteriovenous malformations (HFAVMs) in the extremities.
- To determine the efficacy and safety of various treatment modalities, including conservative management and endovascular embolization.
Main Methods:
- A retrospective review identified 31 patients with extremity HFAVMs between 1988 and 2003.
- Diagnostic imaging included arteriography, duplex ultrasound, and MRI.
- Patient data were analyzed for treatment received, outcomes, and complications over a mean follow-up of 3.3 years.
Main Results:
- Of 31 patients, 13 underwent embolotherapy with N-butyl cyanoacrylate or polyvinyl alcohol over multiple sessions, achieving symptom control in 5 and complete resolution in 3.
- Six patients were unsuitable for embolization due to complex anatomy; two experienced symptom progression.
- Eleven patients with minimal symptoms were managed conservatively, with only one showing symptom progression during follow-up. Major complications occurred in 15.4% of treated patients.
Conclusions:
- Peripheral HFAVMs are rare and challenging to treat.
- Conservative management is effective for patients with mild symptoms, with infrequent progression.
- Embolization should be reserved for patients with significant symptomatology, requiring multiple sessions and aiming for nidus eradication.