E-078 diagnosis and management of intraosseous arteriovenous malformation

Abstract

Purpose AVM of bone is a difficult management problem. Because standard embolic agents (glue, PVA, Onyx, Embospheres, etc.) are not curative and only palliative, ethanol and ethanol with coils are evaluated in an attempt to curatively treat bone AVMs. Extremity bone AVMs are particularly problematic in that patients frequently have multiple AVMs (˜50%). Materials and methods 28 patients (18 f, 10 m); age range 6–48 years, mean: 20 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. No surgery was performed on any patients. Results 26 of 28 patients are cured of their AVM at arteriographic follow-up (range 8 months–120 months; mean: 42 months). 2 patient’s therapy is on-going (mandible/maxilla/face multiple AVMs). Complications include one coil migration to the lung (retrieved without sequelae), three patients with skin injury in the lower extremity (healed uneventfully). One patient required a minor gingival surgery. Conclusions 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 consistently curing these AVMs. When bone AVM is present in an extremity, multiple AVMs in that extremity occur around 50% of the time. Acceptable complication rates are noted in this series that were not debilitating. This minimally invasive form of treatment routinely is efficacious in permanently ablating these difficult lesions that have proven untreatable by other means. Disclosures W. Yakes: None.