2:42 PM Abstract No. 159 - Management of chest and shoulder arteriovenous malformations

Abstract

Purpose PURPOSE: To determine the efficacy of Endovascular Repair of Shoulder arteriovenous malformations (AVMs). Materials and Methods Fifteen patients (10 females, 5 males) presented for repair of shoulder AVMs. Three patients had extension of AVM to the supraclavicular and axillary areas. Two patients had multiple AVMs. Eight patients had previous failed therapies (embo: PVA/coils/gelfoam; surgeries: excisions/bypass). All patients underwent ethanol endovascular AVM repair; seven patients had additional coil embolizations (110 treatments). Patient age range 18-76 years; mean age 47. Results Thirteen patients are cured at long-term follow-up (37 months mean follow-up). One patient with bilateral shoulder AVM and multiple other AVMs therapy is on-going. Another patient’s treatment is on-going. Complications in-clude two patients with minor superficial blisters, one patient with transient nerve injury with complete recovery and one patient with clot embolus to hand, Rx with urokinase w/distal 3rd phalanx removed. Conclusion A recent report of shoulder AVM repair in JVIR documented failure of nBCA approach. These authors stated that shoulder AVMs were not possible to treat. This report documents cure of these difficult lesions is possible with ethanol endovascular and direct puncture approaches. Long-term cures are documented in this patient series despite previous publications stating treatments of these lesions are not possible.