Extremity Arteriovenous Malformations Involving the Bone: Therapeutic Outcomes of Ethanol Embolotherapy

Abstract

To assess retrospectively the therapeutic results, complications, and therapeutic approach to ethanol embolotherapy of extremity arteriovenous malformations (AVMs) involving the bone. From December 1996 to May 2009, 22 patients (12 male, 10 female; eight children, 14 adults; age range, 1-64 years) with extremity AVMs involving the bone underwent staged ethanol embolotherapy (range, 1-12 procedures; mean, 4.4 procedures) under general anesthesia. Four patients had pure bone AVMs and 18 had mixed bone and soft-tissue AVMs. Pulmonary artery pressure and arterial blood pressure were monitored as ethanol was injected. Ethanol embolotherapy was performed by direct puncture and/or transcatheter approach. Therapeutic outcomes were established by evaluation of the clinical response of symptoms and signs, as well as the degree of devascularization at follow-up angiography or computed tomography. Ninety-six ethanol embolotherapy procedures were performed in 22 patients. Four (18%) were cured, 14 (64%) showed improvement, three (14%) showed no change, and one (4%) experienced treatment failure and amputation of the affected extremity. Ethanol embolotherapy was considered effective (ie, combined cure and improvement outcomes) in 18 patients (82%). Ten patients (45%) experienced complications. Twelve minor complications (skin and transient peripheral nerve injury; 13%) and one major complications (longstanding nerve palsy; 1%) occurred in 96 procedures. Ethanol embolotherapy of extremity AVMs involving the bone has the potential to eliminate or improve symptoms in a high percentage of patients, with an acceptable risk of minor and major complications.