Document Detail


Long-term outcome of embolotherapy and surgery for high-flow extremity arteriovenous malformations.
MedLine Citation:
PMID:  11099238     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To assess the long-term efficacy of embolotherapy in combination with surgery for management of symptomatic high-flow arteriovenous malformations (HFAVMs) of the lower and upper extremities. MATERIALS AND METHODS: Twenty consecutive patients with symptomatic high-flow lower extremity AVMs (LE-AVMs; n = 9) and upper extremity AVMs (UE-AVMs; n = 11) were treated from 1982 to 1999. All nine patients with LE-AVM had pain and seven had ulceration of the skin. All 11 patients with UE-AVM had debilitating pain, seven had weakness of the affected hand, and two had bony erosion. Embolization of the nidus beneath the site of maximum pain or ulceration was performed percutaneously from the femoral artery through coaxially placed microcatheters (n = 18) or surgical cutdown (n = 2). Cyanoacrylate (isobutyl or n-butyl) diluted with iophendylate or ethiodized oil was used in 19 of 20 patients. RESULTS: Follow-up was completed in eight of nine patients with LE-AVM (mean, 8.6 y) and nine of 11 patients with UE-AVM (mean, 7.4 y) after treatment. One patient with localized LE-AVM was functioning well 13 years after embolotherapy and another was functioning well 16 years after undergoing three embolotherapy procedures and two skin grafts. Five of nine patients with LE-AVM required below-the-knee (n = 4) or above-the-knee (n = 1) amputation 1-6 years after technically and clinically successful embolotherapy. All three trifurcation arteries were diffusely involved in HFAVM in patients requiring amputation. Healing of the two amputation sites, involved by AVM at the knee, was excellent after preoperative geniculate artery embolotherapy. All 11 patients with UE-AVM experienced marked symptomatic improvement; seven after embolotherapy alone and the other four after resection of AVM. One complication of digital spasm was reversed by administration of nerve blocks. CONCLUSIONS: LE-AVM with diffuse involvement of all three trifurcation arteries ultimately required amputation because of recurrence of symptoms after technically and clinically successful embolotherapy. Cyanoacrylate embolotherapy alone or in combination with surgical resection of the AVM provided excellent long-term palliation in patients with UE-AVM.
Authors:
R I White; J Pollak; J Persing; K J Henderson; J G Thomson; C M Burdge
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of vascular and interventional radiology : JVIR     Volume:  11     ISSN:  1051-0443     ISO Abbreviation:  J Vasc Interv Radiol     Publication Date:    2000 Nov-Dec
Date Detail:
Created Date:  2001-03-15     Completed Date:  2001-05-31     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9203369     Medline TA:  J Vasc Interv Radiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1285-95     Citation Subset:  IM    
Affiliation:
Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8042, USA. white@biomed.med.yale.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Amputation
Arm / blood supply
Arteriovenous Malformations / surgery,  therapy*
Combined Modality Therapy
Contrast Media / administration & dosage
Cyanoacrylates / administration & dosage
Embolization, Therapeutic*
Female
Follow-Up Studies
Humans
Iophendylate / administration & dosage
Leg / blood supply
Male
Middle Aged
Recurrence
Treatment Outcome
Chemical
Reg. No./Substance:
0/Contrast Media; 0/Cyanoacrylates; 99-79-6/Iophendylate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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