ORIGINAL ARTICLE  UPDATE IN VASCULAR ANOMALIES TREATMENT Free access

Italian Journal of Vascular and Endovascular Surgery 2021 March;28(1):3-9

DOI: 10.23736/S1824-4777.21.01485-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Multidisciplinary, single center approach to 261 cases of peripheral arteriovenous malformations: a retrospective analysis

Raul MATTASSI ¹ ✉, Piero DI GIUSEPPE ², Simone GRAPPOLINI ³, Tiziano ZURLO ⁴, Walter POZZOLI ⁵, Luca CRESPI ⁶, Fabio ZERBINATI ⁷, Walter ZULIANI ⁸, Giorgio BRAMBILLA ⁹, Giacomo COLLETTI ¹⁰

¹ Unit of Vascular Surgery, Stefan Belov Center for Vascular Malformations, Humanitas Mater Domini, Castellanza, Varese, Italy; ² Unit of Hand Surgery, Stefan Belov Center for Vascular Malformations, Humanitas Mater Domini, Castellanza, Varese, Italy; ³ Unit of Plastic Surgery, Stefan Belov Center for Vascular Malformations, Humanitas Mater Domini, Castellanza, Varese, Italy; ⁴ Unit of Otorhinolaryngology, Stefan Belov Center for Vascular Malformations, Humanitas Mater Domini, Castellanza, Varese, Italy; ⁵ Unit of Duplex Scan Diagnostic, Stefan Belov Center for Vascular Malformations, Humanitas Mater Domini, Castellanza, Varese, Italy; ⁶ Unit of Radiological Imaging, Stefan Belov Center for Vascular Malformations, Humanitas Mater Domini, Castellanza, Varese, Italy; ⁷ Unit of Orthopedics, Stefan Belov Center for Vascular Malformations, Humanitas Mater Domini, Castellanza, Varese, Italy; ⁸ Unit of General Surgery, Stefan Belov Center for Vascular Malformations, Humanitas Mater Domini, Castellanza, Varese, Italy; ⁹ Unit of Interventional Radiology, Stefan Belov Center for Vascular Malformations, Humanitas Mater Domini, Castellanza, Varese, Italy; ¹⁰ Unit of Maxillofacial Surgery, San Paolo Hospital, Milan, Italy

BACKGROUND: Treatment strategy of arteriovenous malformations (AVM) is difficult and discussed due to variability and different treatment possibilities. Results reported are often limited to an area or to a single technique.
METHODS: Two hundred sixty-one cases of AVM treated by a multidisciplinary group were analyzed. Site of defect and type (limited, infiltrating and direct fistulas) were recorded as well as technique treatment, combination and results. Surgery, embolization, percutaneous alcohol and interstitial laser treatment were used.
RESULTS: One hundred thirty-four (55%) were female and 118 (45%) males. One hundred fifty-four (58%) were infiltrating forms, 100 (39%) limited forms and 7 (3%) direct A-V fistulas. Main location in limited forms was: head and neck (52 [52%]), lower limbs (24 [24%]) and upper limbs (14 [14%]); in infiltrating forms: lower limbs (50 [33%]), upper limbs (43 [28%]) and head and neck (36 [23%]). Sixty-nine patients were not treated because asymptomatic or refuse of the patient. Treatment sessions were in limited forms: percutaneous alcohol occlusion (79), surgery (34), catheter embolization (24) and interstitial laser (6 sessions). In infiltrating forms: alcohol occlusion (119), catheter embolization (106), surgery (31) and interstitial laser (13). A single treatment was done in 48 (63%) of limited cases and in 29 (37%) of infiltrating forms. Combination of treatments was done in 26 (34%) of limited AVM and in 59 (55%) of infiltrating forms. In limited forms: 43 patients were healed with no residual AVM (56%), 18 asymptomatic with residual AVM (24%), 12 improved (15%), 0 unchanged; in infiltrating forms 19 were healed (17%), 26 asymptomatic (24%), 44 improved (41%), 14 unchanged (13%) and 5 amputated (5%). Recurrence was 5% in limited cases and 20% in infiltrating forms.
CONCLUSIONS: Multidisciplinary approach to AVM, having access to all four techniques, is an effective form to treat these diseases. Recurrence had a reduced incidence in this study.

KEY WORDS: Arteriovenous malformations; Arteriovenous fistulas; Embolization, therapeutic; Arteriovenous malformations