Type Of Arteriovenous Malformation Research Articles

Efficacy and safety of embolo-sclerotherapy of arteriovenous malformations with foam sodium tetradecyl sulphate.

To evaluate the efficacy and safety of embolo-sclerotherapy (EST) particularly with foamed sclerotherapy in the treatment of arteriovenous malformations (AVMs). All patients with AVM who underwent interventional therapy i.e. EST from January 1st, 2015 - December 31st, 2019 were identified through a prospective database. Types of AVM were classified according to Schobinger's classification. The outcome measures assessed efficacy and complications. The former was divided into four groups: no response, mild response, moderate response, and complete response.. Complications were defined as any tissue or functional damage, distal embolization or tissue reaction. Continuous variables were compared using analysis of variance (ANOVA) F test and discrete variables were analysed using χ2 tests. P<0.05 was considered significant. A total of 65 patients were included. There was no statistical difference amongst the volume of foam STS 3% or alcohol used across all types of AVM. Overall, majority of patients (86.2%) reported some degree of improvement following interventional therapy. Six (9.2%) patients experienced complications including necrosis and amputation. The proportions of complication were significantly different across the categories (P=0.009). Patients with type III AVM seemed to report more complications than others. Foam sclerotherapy was clinically effective and safe for patients with AVM. This study showed that foam sclerotherapy with STS 3% provided a safe and efficacious alternative sclerosant to ethanol despite it was not often reported to be used to treat AVM. However, a combination of embolic agents is likely required to treat type IV AVMs.

O059 Efficacy and safety of embolo-sclerotherapy of arteriovenous malformation based on the experience from a single specialist centre

Abstract Introduction To evaluate the efficacy and safety of EST, particularly foamed STS 3% in the treatment of arteriovenous malformations (AVMs) in a single specialist centre. Methods All patients with AVMs who underwent EST from 01 January 2015–31 December 2019 were retrospectively reviewed. Types of AVM were grouped into Schobinger's classification. All ESTs were performed either with foam sclerosants (STS 3% and polidocanol), ethanol, coils and/or other substances including Onyx and Gelfoam. Outcome measures included treatment effects and complications. Continuous variables were compared using ANOVA F test. Other discrete variables were compared using Chi-squared tests. Differences were considered significant at p&amp;lt;0.05. Results A total of 65 patients with AVMs, with a mean age of 36 years (range 1–74 years) were included. The age of patients with Type IV AVM were significantly (p=0.014) higher than others. The use of EST with foam STS was significantly lower for type IV AVM (0.0%) (p=0.003). Complications were significantly higher in type III AVM (21.1%)) (p=0.009). A total of 6 (9.2%) patients experienced complications for example, upper lip necrosis and partial facial weakness. The number of days in follow-up was not significantly different across all types of AVM. However, type II AVM showed a significantly lower number of days in follow-up (p=0.038). Conclusion EST, in particular foam sclerotherapy with STS 3%, was clinically effective and safe to treat patients with AVM. This study showed that foam sclerotherapy with STS 3% may be used as an alternative to ethanol in the treatment of AVMs. Take-home message EST, in particular foam sclerotherapy with STS 3%, was clinically effective and safe to treat patients with AVM. This study showed that foam sclerotherapy with STS 3% may be used as an alternative to ethanol in the treatment of AVMs.

Arteriovenous malformation that caused prolapse of the colon and was treated surgically in an infant: a case report

BackgroundVarious terms have been used to describe vascular lesions in the intestine, including angiodysplasia, arteriovenous malformation, and telangiectasia. Such lesions are common in adults and are typified by angiodysplasia, a type of arteriovenous malformation. In contrast, these lesions are rarely seen in the pediatric population. Angiodysplasia may cause gastrointestinal bleeding, which is sometimes an indication for treatment. Considering the high rate of recurrence after surgical treatment, conservative treatments are mainly chosen. We herein report an extremely rare case of a prolapsed colon due to an arteriovenous malformation successfully treated by resection in a 1-year-old girl. We also highlight the differences between pediatric and adult cases.Case presentationA girl developed bloody stools at 7 months of age. She visited another hospital at 1 year of age because of continuing moderate hematochezia and recent onset of rectal prolapse. Colonoscopy showed a protruding lesion located 15 cm from the anal verge, suggesting a submucosal vascular abnormality. Contrast-enhanced computed tomography and magnetic resonance imaging at our hospital revealed the localized lesion with dilated blood vessels in part of the sigmoid colon; no other lesions were present in the gastrointestinal tract. Laparoscopic-assisted sigmoidectomy was performed. A subserosal vascular lesion was visualized and resected using end-to-end anastomosis. Pathologic examination of the 2.2 × 2.7-cm segment revealed several abnormally enlarged and ectatic blood vessels in the submucosa extending into the subserosa. The lesion was diagnosed as an arteriovenous malformation. The patient had a good clinical course without recurrence at the 2-year follow-up.ConclusionsAn arteriovenous malformation in the sigmoid colon may rarely cause intussusception and prolapse of the colon. Complete resection is a radical and potentially effective treatment. Computed tomography and colonoscopy were useful for evaluation of the lesion in the present case.

3:18 PM Abstract No. 103 Balloon-assisted Onyx embolization of high-flow peripheral arteriovenous malformations with dual-lumen coaxial balloon microcatheter: technical aspects and clinical results

The aim of this study was to demonstrate our experience in balloon-assisted Onyx (ethylene vinyl alcohol copolymer) embolization of high-flow peripheral arteriovenous malformations (AVMs) using dual-lumen coaxial balloon microcatheter technique, which does not necessitate a plug formation around the catheter that is required to allow antegrade flow of Onyx while preventing reflux and non-target embolization. This study expands the technique with its utilization on types of AVMs not described previously. Three patients with peripheral high-flow AVMs treated with balloon-assisted Onyx embolization using dual-lumen coaxial balloon microcatheter were retrospectively analyzed. AVMs were located in the kidney, pelvis, and chest wall. One patient required two sessions of Onyx embolization treatment. A total of 4 sessions were performed with Onyx 18 and/or Onyx 34 using Scepter XC occlusion balloon catheter. Imaging and clinical follow-ups were performed for all patients. Technical success was achieved in all patients. Complete devascularization was obtained in two patients with renal and pelvic AVMs with one treatment, while the patient with chest wall AVM required two sessions, which resulted in complete devascularization. There was no evidence of excessive reflux of Onyx or entrapment of the microcatheter. Non-target Onyx embolization or microcatheter fracture was not observed. After the final treatment, all patients were free of symptoms on clinical follow-up, and there was no evidence of recurrence identified on follow-up imaging. From our single-institutional experience, the technique using dual-lumen coaxial balloon microcatheter for balloon-assisted Onyx embolization appears to be safe and effective in treating high-flow peripheral AVMs, while allowing more precise injection of Onyx with the capability to reduce the risks associated with reflux of Onyx.

Feeding and Draining Vessel Ligation with Sclerotherapy of High Flow Arteriovenous Malformations in the Head and Neck

Feeding and Draining Vessel Ligation with Sclerotherapy of High Flow Arteriovenous Malformations in the Head and Neck

Lumbociática como forma de presentación de una malformación vascular: síndrome de Foix-Alajouanine

Sciatica and low back pain are the most frequent reasons for skeletal muscle consultation in primary and specialized care. Spinal cord vascular malformations, among them arteriovenous fistulae, are a rare but a treatable condition of progressive paraplegia and tetraplegia. The initial symptoms may be radicular and lumbar pain, weakness and sphincters disorders, among others. The pathophysiology of these malformations explains the presentation form related to efforts and such variable clinical symptoms according to the variation of venous pressure. A differential diagnosis must be made in regards to other diseases that have neurological symptoms. Early diagnosis and treatment can prevent the disease-progression.We report the case of a 40-year old man initially diagnosed of sciatica that evolved to acute paraparesia. Finally, he was diagnosed of spinal arteriovenous fistula. We describe the different types of arteriovenous malformations and their pathophysiology.

Multimodality management of Spetzler-Martin Grade III arteriovenous malformations

Grade III arteriovenous malformations (AVMs) are diverse because of their variations in size (S), location in eloquent cortex (E), and presence of central venous drainage (V). Because they may have implications for management and outcome, the authors evaluated these variations in the present study. Between 1984 and 2010, 100 patients with Grade III AVMs were treated. The AVMs were categorized by Spetzler-Martin characteristics as follows: Type 1 = S1E1V1, Type 2 = S2E1V0, Type 3 = S2E0V1, and Type 4 = S3E0V0. The occurrence of a new neurological deficit, functional status (based on modified Rankin Scale [mRS] score) at discharge and follow-up, and radiological obliteration were correlated with demographic and morphological characteristics. One hundred patients (49 female and 51 male; age range 5-68 years, mean 35.8 years) were evaluated. The size of AVMs was less than 3 cm in 28 patients, 3-6 cm in 71, and greater than 6 cm in 1; 86 AVMs were located in eloquent cortex and 38 had central drainage. The AVMs were Type 1 in 28 cases, Type 2 in 60, Type 3 in 11, and Type 4 in 1. The authors performed embolization in 77 patients (175 procedures), surgery in 64 patients (74 surgeries), and radiosurgery in 49 patients (44 primary and 5 postoperative). The mortality rate following the management of these AVMs was 1%. Fourteen patients (14%) had new neurological deficits, with 5 (5%) being disabling (mRS score > 2) and 9 (9%) being nondisabling (mRS score ≤ 2) events. Patients with Type 1 AVMs (small size) had the best outcome, with 1 (3.6%) in 28 having a new neurological deficit, compared with 72 patients with larger AVMs, of whom 13 (18.1%) had a new neurological deficit (p < 0.002). Older age (> 40 years), malformation size > 3 cm, and nonhemorrhagic presentation predicted the occurrence of new deficits (p < 0.002). Sex, eloquent cortex, and venous drainage did not confer any benefit. In 89 cases follow-up was adequate for data to be included in the obliteration analysis. The AVM was obliterated in 78 patients (87.6%), 69 of them (88.5%) demonstrated on angiography and 9 on MRI /MR angiography. There was no difference between obliteration rates between different types of AVMs, size, eloquence, and drainage. Age, sex, and clinical presentation also did not predict obliteration. Multimodality management of Grade III AVMs results in a high rate of obliteration, which was not influenced by size, venous drainage, or eloquent location. However, the development of new neurological deficits did correlate with size, whereas eloquence and venous drainage did not affect the neurological complication rate. The authors propose subclassifying the Grade III AVMs according to their size (< 3 and ≥ 3 cm) to account for treatment risk.

Open surgical disconnection for congenital, multi-hole, pial arteriovenous fistulae in non-eloquent cortex

Intracranial pial arteriovenous fistulae (pAVFs), a direct shunt between a feeding artery and a venous channel with the absence of a true nidus characteristic of other types of arteriovenous malformations, are rare. We report a seven-year-old girl with an incidental intracranial pAVF. Following partial embolization with a combination of platinum coils and liquid embolic material, this lesion was surgically disconnected and a definitive cure was achieved. Based on the particular characteristics of this lesion-multiple, small arterial feeders, superficial location, and proximity to the non-eloquent cortex-we feel this vascular lesion represents a subset of pAVFs that may be most reasonably and safely treated by open surgery. While staged embolization has recently gained popularity as a treatment option, the additive risk of multiple embolizations as well as repeated exposure to ionizing radiation should not be understated, especially in the pediatric population. Furthermore, given the paucity of data on the long-term effectiveness of embolization, surgery remains an elegant and durable treatment option for pAVFs in carefully selected patients.

Bases patogénicas de la epileptogénesis en los cavernomas cerebrales

INTRODUCTION. Brain cavernoma are a type of arteriovenous malformation that clinically presenting seizures, neurological deficit or bleeding. Hypoxia, neoangiogenesis and metalloproteasas seems to be involved in seizures physiopathology. Our study aims to assess this potential relation by immunohistochemical methods, analyzing hypoxia inducible factor (HIF-1alpha) and metalloproteasa (MMP-9) in tissue surrounding cavernoma. PATIENTS AND METHODS. We selected 17 consecutive cases anatomopathologically diagnosed as cavernoma during 9 years. Immunohistochemical staining was performed for HIF-1alpha and MMP-9. We evaluated the relation between seizures and the scale of uptake of different tissues surrounding cavernoma. RESULTS. Cases with seizures had HIF-1alpha positive uptake in vascular endothelium in 31%, 17% in fibrous tissue and 34% in inflammatory tissue. Besides, it also shows MMP-9 positive uptake in vascular endothelium in 86%, 100% in fibrous tissue and 43% of brain tissue. Statistical analysis by chi-square and odds ratio shows a positive trend towards seizures and the presence of HIF-1alpha and MMP-9 in vascular tissue, fibrous tissue and brain tissue, but no for inflammatory tissue. CONCLUSION. HIF-1alpha and MMP-9, valued by immunohistochemical methods, are related to complications as seizures.

Manejo de la lesión medular debida a una malformación arteriovenosa

Arteriovenous malformations (AVM) in the spinal cord are uncommon. Depending on the type of AVM, different types of damage to the spinal cord are caused. In this clinical case, a 34-year-old man with paresthesia and progressive paraparesis was diagnosed with acute thoracic myelopathy using magnetic resonance imaging; angiography of the spinal cord revealed an arteriovenous fistula. Treatment of AVM aims to reestablish normal flow in the arteriovenous vascularization of the spinal cord by endovascular embolization of the fistula. Rehabilitation treatment is directed toward achieving the minimum disability possible. In this case, it consisted of strengthening the different muscle groups through kinesitherapy and electrostimulation in order to achieve their total independence when carrying out routine daily activities.

SPONTANEOUS REGRESSION OF A RENAL ARTERIOVENOUS MALFORMATION

A renal arteriovenous fistula is an anomalous connection between the arterial and venous systems. An acquired type of arteriovenous malformation, especially after percutaneous renal biopsy, often resolves within a few months. However, most symptomatic congenital arteriovenous malformations require surgical or interventional therapy and their natural history remains unknown. We report a case of spontaneous regression of a congenital type of arteriovenous malformation.

Long-term follow-up of craniovertebral junction arteriovenous fistulas surgically treated by feeder obliteration: report of three cases

Craniovertebral junction arteriovenous fistulas are still rare and are viewed differently from other arteriovenous fistulas because of their specificity of location and treatment. Intravascular treatment has come to play an important role in this area, but it is still controversial in terms of safety and reliability for complete obliteration. From the anatomical point of view, direct surgery seems to be more efficient and safe than endovascular therapy based on our experience with three surgically treated cases. In all three cases, the surgical approach was intended to obliterate the feeders in the vicinity of the nidus. In 2 of 3 cases, follow-up angiography showed complete obliteration of the fistulas and one case showed partial obliteration. No recurrence of symptoms was encountered 4–7 years postoperatively. Surgical treatment is still advantageous over intravascular treatment in this type of arteriovenous malformation. Simple surgical fistulous obliteration may lead to the gradual complete disappearance of this malformation.

Arteriovenous malformation of the vein of Galen: A rare cerebral arteriovenous malformation

A 32-year-old male presented to the emergency department for evaluation of a 12-day history of altered mental status. Workup revealed the presence of an arteriovenous malformation (AVM) of the great vein of Galen, an exceedingly rare and often fatal type of cerebral vascular malformation. Concurrent aneurysmic dilatation of the vein, a frequent finding associated with this type of AVM, resulted in compression of the aqueduct of Sylvius and acute hydrocephalus. A brief review of cerebral AVMs is presented, with specific attention to the pathophysiology, clinical presentation, and emergent treatment of those that involve the vein of Galen.

Intrarenal Arteriovenous Malformation

Our surgical experience with 7 cases of intrarenal vascular malformation is reported. Based on angiographic criteria the so-called congenital arteriovenous fistula of the kidney may be classified either as the cirsoid type, which represents a truly congenital form of arteriovenous malformation, or as the aneurysmal type, which is considered to be idiopathic or spontaneous. These 2 types of arteriovenous malformations are compared with regard to clinical presentation and the choice of surgical treatment for each type is discussed.