Long-term Excess Mortality in 623 Patients with Brain Arteriovenous Malformations

Abstract

Long-term follow-up studies in patients with brain arteriovenous malformations (AVM) have been scarce and without proper statistical estimates of mortality. We performed a retrospective survival study in 623 consecutive patients with AVMs admitted to the Department of Neurosurgery in Helsinki University Hospital between 1951 and 2005. Patients were followed from admission until death or the end of 2005. Patient survival was estimated using the relative survival ratio, which provides a measure of the excess mortality experienced by the patients compared with the general Finnish population matched by age, sex, and calendar time. Median follow-up was 11.9 years, and total follow-up was 10,165 person-years. Treatment was conservative in 155 patients. Total AVM occlusion was attained in 356 patients, and partial occlusion was obtained in 94 patients. Overall, 206 deaths were observed. Of these, 100 were related to AVMs. Diagnosis of AVM was associated with significant long-term excess mortality, with cumulative relative survival ratios of 0.85 (95% confidence interval, 0.81-0.88) and 0.69 (95% confidence interval, 0.62-0.75) at 10 and 30 years after admission, respectively. Men had higher excess mortality than women. The excess in mortality was highest in conservatively treated patients, intermediate in patients with partially occluded AVMs, and lowest in those with totally occluded AVMs. The subgroup with the best outcome consisted of those with totally occluded unruptured AVMs, which did not demonstrate excess mortality after the first year. AVMs are associated with long-term excess mortality that may be reduced by active, even partial, treatment. Male patients have a higher excess mortality rate than female patients.