Arteriovenous Malformations: Clinical Aspects and Surgical Results

Abstract

Arteriovenous malformations (AVM) are vascular malformations, broadband, formed of arterial and venous dysmorphic vessels interconnected directly without transition in a capillary bed. Arteriovenous malformation surgery is particularly demanding owing to the need to control bleeding. This is probably one of the most critical moments of arteriovenous malformation surgery. The purpose of this study is to analyzed the clinical aspects and evaluate the results of surgery in the treatment of these AVMs. This is a retrospective and descriptive study that took place in Dakar over a period from January 2004 to December 2017 on patients operated for arteriovenous malformations. The total number of our series was 11 cases. These AVMs represented 32.35% of all tumors and vascular malformations operated during this period. The mean age at surgery was 25 years old [1 year-56 years old]. A male predominance was noted with 7 male to 4 female (sex ratio 1.75). The average time of consultation was 8.3 years [1 months-30 months]. The main reason for consultation was the appearance of a mass in 11 cas. We noted a notion of traumatism or recent surgery were done in 4/11 before the onset of symptoms. The location of the lesions was at the head or the face (5 cases), neck (1 case), the upper member (2 cases), the lower member (3 cases). No multiple location were noted. After physical examination, two patients were classified Schobinger stage 1, stage 2 in 7 cases, 2 cases in stage 3. No patient was classified stage 4. The vascular Doppler ultrasound was performed in 10 cases (91%) and allowed to confirm the diagnosis in 10 cases. The CT angiography was performed in 8 cases (73%). It elicited the feeding artery and draining veins, the number of nidus and topography. We found 6 truncal AVM and 5 extratruncal including 4 limited. A first embolization was performed in 2 cases (18.2%). A one-stage surgery was performed in 7 cases and two times in 4 cases. The average hospital stay was 15 days [3 days-60 days]. The average healing time was 18 days [15 days-30 days]. Operative mortality as early mortality was zero. Late mortality was zero. The average follow-up time was 50.3 months [2 months-96 months]. In recent years, the multidisciplinary approach of tumors and vascular malformations has made important advances in the delineation of nosological frameworks and in the understanding of the natural history and structure of these complex lesions. This is why the treatment of these AVMs requires a multidisciplinary consultation exchange between vascular surgeons, plastic surgeons, interventional radiologists and anesthetists.