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International Angiology 2021 Jan 26

DOI: 10.23736/S0392-9590.21.04598-3


language: English

Endovascular approach for arteriovenous limb malformations: a single center experience

Daniele BISSACCO 1, 2 , Fabiane BARBOSA 2, Enza L. CASTRONOVO 1, Angela ALFONSI 2, Marco SOLCIA 2, Antonio RAMPOLDI 2

1 School of Vascular Surgery, Università degli Studi di Milano, Milan, Italy; 2 Interventional Radiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy


BACKGROUND: To assess imaging findings, describe endovascular technical aspects and analyzed procedural outcomes in a population of patients underwent limb arteriovenous malformation (LAVMs).
METHODS: From January 2015 to December 2018, all consecutive patients underwent an endovascular procedure for ICD-9-CM codex for arteriovenous malformation problems were retrospective reviewed. Among these, patients with LAVMs were selected. Demographic, preoperative imaging, interventional and postprocedural data were collected for each patient and procedure. The International Society of Vascular Anomalies, the Cho-Do angiographic classification and the Schobinger clinical stage were used to describe disease type, aspect and clinical severity. Angiographic and clinical outcomes were also described.
RESULTS: During the study period, 76 intervention for AVMs were performed in 52 patients. Among these, 26 LAVMs were selected and analyzed in 21 patients (number of LAVMs per patient: 1.2±0.5), 14 affecting upper limbs, 17 lower limbs. Pain, discomfort and swelling were main symptoms reported (95%, 90% and 62%, respectively). Ultrasound Scan, Computed Angiography Tomography and Magnetic Resonance Angiography were used - alone or in combination - as preoperative imaging in 67%, 62% and 48% of patients, respectively. Cho-Do class ≥3 was described in 70% of treated LAVMs and a Schobinger stage ≥2 in more than 90%. Ipsilateral femoral access with a 5F introducer was preferred. Selective embolization with glue was the most preferred technique (57%), in combination or not with microsphere embolization (19%) and/or direct nidus sclerotherapy (14%). Optimal and suboptimal results were achieved in 86% of cases. Further interventions were performed in 52% of cases, with more than two interventions in 29% of cases.
CONCLUSIONS: Quality of life, clinical picture and anatomical structure are items of paramount importance during preoperative LAVMs endovascular treatment planning. Treatment must be focused on LAVMs type, minimizing invasiveness and number of interventions, although secondary intervention rate remains quite high.

KEY WORDS: Arteriovenous malformation; Endovascular therapy; Embolization; Catheterization

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