Effect of interventional embolization based on absolute ethanol for peripheral arteriovenous malformations

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Medical Imaging

Background:

• Absolute ethanol is a common embolic agent for peripheral arteriovenous malformations (PAVMs).
• Treatment strategies are often guided by PAVM classification systems.
• Optimizing embolization schedules is crucial for effective PAVM treatment.

Purpose of the Study:

• To evaluate the effectiveness of different interventional embolization schedules using absolute ethanol for PAVMs.
• To determine if embolization outcomes correlate with PAVM classification.
• To compare the efficacy of various embolic agents and combinations for different PAVM types.

Main Methods:

• A retrospective study of 165 PAVM patients treated with absolute ethanol embolization.
• PAVMs were classified using the Yakes system (Types II, III, and IV).
• Angiographic devascularization was used to assess embolization effectiveness (total, near-total, substantial, partial, failure).

Main Results:

• PAVMs were predominantly Type II (n=67), Type III (n=81), and Type IV (n=17), with most occurring in the maxillofacial region.
• Significant differences in angiographic outcomes and failure rates were observed across different Yakes classifications and treatment methods (P<0.05).
• Type II PAVMs showed better outcomes with spring coils and absolute ethanol compared to Types III and IV.

Conclusions:

• Embolization outcomes for PAVMs vary significantly based on Yakes classification.
• Type II PAVMs achieve optimal results with spring coils and absolute ethanol.
• Combined therapies for Types III and IV PAVMs, including Pingyangmycin + iodized oil + PVA + absolute ethanol and spring coil + absolute ethanol, yielded less ideal results, with wound complications being most common.