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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2012 March;19(1):41-9
Diagnostic-therapeutic paths and socio-economical remarks in a group of 35 patients affected by arteriovenous malformations
Orlando S. 2, Cornalba G. 2, Brambilla G. 3, Pedicini V. 3, Poretti D. 3, Bordoni M. G. 1, Vercellio G. 1
1 Unit of Vascular Surgery II, Humanitas Hospital, Milan, Italy;
2 Diagnostic Radiology, S. Paolo Hospital, Milan, Italy;
3 Unit of Interventional Radiology, Humanitas Hospital, Milan, Italy
Aim. The aim of this study is to analyse the reports of the therapeutic passages and the socio-economic remarks in a group of 35 patients affected by AVMs.
Methods. During a 15-months-period we recruited and hospitalized 11 males and 24 females, aged between 7 and 45 years and affected by AVM in different localization and clinical stage. Three patients directly underwent to surgical excision, 19 to palliative, 7 to presurgical and 6 to complementary embolization. All patients or theirs relatives (for 3 pediatric patients) answered to a questionnaire to analyse: a) socio-cultural background b) previous treatments c) related economic remarks.
Results. A) Seventy-four percent of adults patients results graduated or has got academic degree, 80% declared to know at least two foreign languages, just 3 of 26 adults declared to be married or to be in a stable relationship; B) 24 patients (68.5%) came from others regions, 30 (85.7%) underwent to previous treatments of surgery or embolization (from 1 to 8) without significant benefits; C) the previous expenses covered by patients were included in a wide range and were over €50000 for 5 patients. Against the good short-terms results of the therapeutic procedures (absence of symptoms for 9, improvement for 26 patients), the regional refund for a single procedure, according to the current DRG, ranged from a minimum of € 139 up to a maximum of €1196.
Conclusion. The group of patients we studied came from different regions and was curiously homogenous for socio-economic and cultural background. From this study stands up the critical management of AVMs according to the multiple previous treatments, often inadequate, with evidence of psychological conditioning and important relapses in the quality of life, especially for interpersonal relationship.
We confirm the importance of multi-disciplinary institutions with a specialized team approach, in order to guarantee an appropriate care in the management of this group of rare and severe vascular anomalies.