2:42 PM Abstract No. 43 - Embolization of intraosseous AVM

Abstract

Purpose AVM of bone is a difficult management problem. Because standard embolic agents (glue, PVA, Onyx, Embospheres, etc.) are rarely curative and only palliative, ethanol and ethanol with coils are evaluated to curatively treat bone AVMs. Materials and Methods Twenty-nine patients (17 f, 12 m); age range 6 - 48 years, mean: 19 years) presented with bone AVMs involving the upper extremity, lower extremity, pelvis, spine, and head and neck areas. All patients underwent MR, arteriography, and endovascular repair of their bone AVMs. Ethanol alone and ethanol with coils were the sole embolic agents. Results Twenty-eight of twenty-nine patients are cured of their intraosseous AVM at follow-up (range 8 months - 120 months; mean: 42 months). One patient’s therapy is on-going (mandible/maxilla/face AVMs). Complications include one coil migration to the lung (retrieved without sequelae), three patients with skin injury in the lower extremity (healed uneventfully), and one patient with chronic weakness left quadriceps femoris muscle group, which was present prior to treatment and not improved with treatment of her pelvic/iliac wing AVM. Conclusion Bone AVMs in the literature are rarely cured, save by amputation. Ethanol or ethanol with coils has proven to be consistent in ablating bone AVMs and durable at long-term follow-up, in essence curing the AVM. When bone AVM is present in an extremity, multiple AVMs in that extremity can occur. Acceptable low complication rates are noted in this series.