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Taxak A, Verma M, Pandey NN, Singh V, Kumar S, Jagia P. Efficacy and Safety of Venous Sac Embolization With or Without Feeding Artery Embolization Versus Feeding Artery Embolization Alone in the Management of Pulmonary Arteriovenous Malformations: A Systematic Review and Meta-analysis. J Endovasc Ther 2024; 31:421-427. [PMID: 36147015 DOI: 10.1177/15266028221125582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate by meta-analysis the safety and efficacy of venous sac embolization (VSE) with or without feeding artery embolization versus feeding artery embolization (FAE) alone in the management of pulmonary arteriovenous malformations (PAVMs). METHODS This systematic review and meta-analysis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was performed in MEDLINE, Embase, and Scopus till August 31, 2021 to identify studies comparing the safety and efficacy of VSE with or without FAE versus FAE alone in PAVMs. The success of treatment was assessed by comparing the number of PAVMs with ≥70% decrease in the size of draining vein/sac between the 2 groups. The pooled odds ratio (OR) and 95% confidence interval (95% CI) were calculated using the random-effects inverse-variance model and were used to compare pooled therapeutic efficacy between the groups. RESULTS Three studies were found eligible for the meta-analysis. The included studies had a total of 169 patients (119 females and 50 males). The total number of PAVMs was 298, and hereditary hemorrhagic telangiectasia was present in 119 patients. The success of treatment was higher with VSE as compared to FAE (OR=3.54, 95% CI=1.66-7.56). The minor complications were similar in both groups, and one major complication occurred in the FAE group. More coils were used in the VSE group. CONCLUSIONS The present systematic review and meta-analysis has consolidated the evidence that VSE with or without FAE is more efficacious than FAE alone in the management of PAVMs without any increase in the associated risk of sac rupture or coil migration. CLINICAL IMPACT Until high-quality data from a prospective, multicentric, randomized controlled trial becomes available, the evidence consolidated by the present systematic review and meta-analysis showing the efficacy of venous sac embolization (with or without feeding artery embolization) over feeding artery embolization alone, can be used for clinical decision-making in the management of pulmonary arterio-venous malformations.
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Affiliation(s)
- Avichala Taxak
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwajeet Singh
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Shen Y, Wang D, Fan X, Zheng L, Su L, Yang X. Ethanol embolization of arteriovenous malformations in the buttock: ten-year experiences in diagnoses and treatment options. Orphanet J Rare Dis 2024; 19:195. [PMID: 38741122 DOI: 10.1186/s13023-024-03205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 05/05/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Clinically, arteriovenous malformations in the buttocks (bAVMs) are extremely rare. Our study aimed to evaluate the efficacy and safety of ethanol embolotherapy in managing bAVMs. RESULTS A total of 32 patients with bAVMs (14 females and 18 males) from 2012 to 2021 were included in this study. All patients underwent complete clinical and imaging examinations. Further, the AVMs lesions were analyzed according to Schöbinger staging and Yakes classification. Each patient had undergone a multistage ethanol embolization. The amelioration of clinical symptoms and devascularization on angiography were evaluated at regular follow-ups. In the present cohort, the 11-20 age group had the most patients (15/32; 46.88%). A total of 124 embolization procedures were performed (average 3.88 procedures per patient), and the average dose of absolute ethanol was 18.96 mL per procedure. Thirteen patients with dominant draining veins underwent additional coil deployment before ethanol embolization (13/32; 40.63%). During follow-ups, clinical improvement was found in 23 of 27 who presented with a pulsating mass (85.19%), 17 of 20 with abnormal local skin temperature (85%), 5 of 6 with bleeding (83.33%), and 5 of 5 patients treated for pain (100%). More than 75% angiographic devascularization was achieved in 18 patients (18/32; 56.25%). Finally, 12 out of 13 patients (92.31%) reduced from Schöbinger Stage III to a lower grade, and ten patients exhibited a complete response (10/32; 31.23%). There was a single serious complication of local necrosis, while neither paranesthesia nor infection was observed postoperatively. CONCLUSIONS Ethanol embolization assisted with coils can treat bAVMs effectively and safely. The Yakes classification contributed to the optimal ethanol embolotherapy of bAVMs.
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Affiliation(s)
- Yuchen Shen
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Deming Wang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Xindong Fan
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Lianzhou Zheng
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai, 200011, China
| | - Lixin Su
- Fengcheng Hospital of Feng Xian District, Fengcheng Branch, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201413, China.
| | - Xitao Yang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Rd, Shanghai, 200011, China.
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Dimagli A, Malas J, Chen S, Sandner S, Schwann T, Tatoulis J, Puskas J, Bowdish ME, Gaudino M. Coronary Artery Aneurysms, Arteriovenous Malformations, and Spontaneous Dissections-A Review of the Evidence. Ann Thorac Surg 2024; 117:887-896. [PMID: 38081498 DOI: 10.1016/j.athoracsur.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Coronary artery aneurysms (CAAs), coronary arteriovenous malformations (CAVMs), and spontaneous coronary artery dissections (SCADs) are rare clinical entities, and much is unknown about their natural history, prognosis, and management. METHODS A systematic search of MEDLINE, Embase, and Cochrane Library databases was performed in March 2023 to identify published papers related to CAAs, CAVMs, and SCADs. RESULTS CAAs are found in 0.3% to 12% of patients undergoing angiography and are often associated with coronary atherosclerosis. They are usually asymptomatic but can be complicated by thrombosis in up to 4.8% of patients and rarely by rupture (0.2%). CAAs can be managed medically, percutaneously with stents or coil embolization, and surgically. The most common surgical procedure is ligation of the aneurysm, followed by coronary artery bypass grafting. The incidence of CAVMs is 0.1% to 0.2% in patients undergoing angiography, and they are most likely associated with congenital abnormal development of the coronary vessels. The diagnosis of CAVMs is usually incidental. Surgical or percutaneous intervention is indicated for patients with large CAVMs, which carry a potential risk of myocardial infarction. SCADs represent 1% to 4% of all acute coronary syndromes and typically affect young women. SCADs are strongly correlated with pregnancy, suggesting the role of sex hormones in their pathogenesis. Conservative management of SCAD is preferred for stable patients without signs of ischemia as spontaneous resolution is frequently reported. Unstable patients should undergo revascularization either percutaneously or with coronary artery bypass grafting. CONCLUSIONS Further evidence regarding the management of these rare diseases is needed and can ideally be derived from multicenter collaborations.
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Affiliation(s)
- Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Jad Malas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sarah Chen
- Division of Cardiac Surgery, University of California Davis Health, Sacramento, California
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schwann
- Department of Surgery, University of Massachusetts-Baystate, Springfield, Massachusetts
| | - James Tatoulis
- The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, New York
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
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Rethinasamy R, Penubarthi LK, Gopalakishnan Srinivasan D, Alexander A. Tumescent solution: a game changer in excising refractory arteriovenous malformation. BMJ Case Rep 2024; 17:e257483. [PMID: 38684349 DOI: 10.1136/bcr-2023-257483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Arteriovenous malformations of the head and neck are rare and inborn errors of vascular morphogenesis. They pose therapeutic challenges owing to their bleeding tendency and a high chance of recurrence. Treatment modalities include digital subtraction angiography with embolisation as a primary treatment or can be done preoperatively followed by surgical excision. We present a case of recurrent arteriovenous malformation of the postauricular region in an adolescent male who was taken up for upfront surgical excision with the help of a tumescent solution, thereby eliminating the need for embolisation and drastically reduced intraoperative blood loss.
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Affiliation(s)
- Ramkumar Rethinasamy
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Lokesh Kumar Penubarthi
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Arun Alexander
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Marchiori E, Hochhegger B, Zanetti G. Arteriovenous malformation. J Bras Pneumol 2024; 50:e20240023. [PMID: 38536987 PMCID: PMC11095919 DOI: 10.36416/1806-3756/e20240023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Affiliation(s)
- Edson Marchiori
- Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Hayashida Y, Murakami Y, Fukumitsu S, Yoshimatsu Y, Anai K, Todoroki Y, Fujisaki A, Ide S, Aoki T. Feasibility of Breath-Hold Zero TE Magnetic Resonance Imaging Sequence for Evaluation of Pulmonary Arteriovenous Malformations After Embolotherapy. J Comput Assist Tomogr 2024; 48:233-235. [PMID: 38110292 DOI: 10.1097/rct.0000000000001568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
ABSTRACT We obtained breath-hold zero TE (ZTE) magnetic resonance imaging for the evaluation of pulmonary arteriovenous malformations before and after embolotherapy. To the best of our knowledge, there have been no reports of ZTE for the entire lung imaging in single breath-hold scan time such as 20 seconds. Breath-hold ZTE magnetic resonance imaging can be a useful technique for magnetic resonance-based follow-up of vascular lung diseases without using contrast media, reducing the undesired artifacts from metallic devices.
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Affiliation(s)
- Yoshiko Hayashida
- From the Department of Radiology, University of Occupational and Environmental Health, Fukuoka, Japan
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Latif MA, Bailey C, Weiss CR. Persistence After Treatment of Pulmonary Arteriovenous Malformations in Children. Cardiovasc Intervent Radiol 2024; 47:394-396. [PMID: 38062174 DOI: 10.1007/s00270-023-03625-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/14/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Muhammad A Latif
- Russell H. Morgan Department of Radiology and Radiological Science, Interventional Radiology Center, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Suite 7, 1800 Orleans Street, Baltimore, MD, 21287, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher Bailey
- Russell H. Morgan Department of Radiology and Radiological Science, Interventional Radiology Center, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Suite 7, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, Interventional Radiology Center, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Suite 7, 1800 Orleans Street, Baltimore, MD, 21287, USA.
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Adams RC, Hegde S, Sutphin P, Iqbal S, Irani Z, Kalva SP. Use of Polyurethane-Covered Stents for Exclusion of Pulmonary Arteriovenous Malformations. Cardiovasc Intervent Radiol 2024; 47:360-365. [PMID: 38180506 DOI: 10.1007/s00270-023-03638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE To evaluate the safety, technical success and short-term effectiveness of polyurethane-covered stent (PK Papyrus, BioTronik, Berlin) in the treatment of pulmonary arteriovenous malformations (PAVMs) that are not amenable to embolotherapy. MATERIALS AND METHODS In this IRB-approved, retrospective study, data from patients who received polyurethane-covered stents for exclusion of PAVMs were analyzed. The study included 5 patients (all women) with a median age of 40 years (range 25-60). Patients presented with hypoxemia, TIAs, and/or epistaxis; 4 were confirmed to have HHT. All had multiple PAVMs diagnosed on chest CT and underwent embolization with other devices in addition to the polyurethane-covered stent. The indication for stent placement in all cases was a short and/or tortuous feeding artery. Safety was assessed by immediate or short-term complications, e.g., migration, stent thrombosis, and fracture. Technical success was defined as the ability to accurately place the stent at the intended location. Effectiveness was defined as successful exclusion of PAVM with no perfusion across the AVM. RESULTS Technical success of stent placement was 100%. AVM exclusion rate was 80% after single stent deployment; in the case of incomplete exclusion, success was achieved using an overlapping stent to completely cover a second feeding artery. During the median follow-up period of 5 months (range 2-10), all stents remained patent, and AVMs were excluded without other complications. CONCLUSION Exclusion of PAVMs with polyurethane-covered stents is technically feasible, safe, and shows short-term effectiveness for PAVMs with a short/tortuous feeding artery when traditional embolization techniques are not possible.
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Affiliation(s)
- Ryan C Adams
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA.
| | - Siddhi Hegde
- Abdominal Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick Sutphin
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Shams Iqbal
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Zubin Irani
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Sanjeeva P Kalva
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
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Gong AJ, Bosworth EC, Garg T, Weiss CR. Prospective Study of Polytetrafluoroethylene-Covered Microplugs and Detachable Coils for Embolization of Pulmonary Arteriovenous Malformations: Technical Results, Procedure Times, and Costs. J Vasc Interv Radiol 2024; 35:362-369. [PMID: 38123126 DOI: 10.1016/j.jvir.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/17/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To determine time to occlusion and procedure costs of embolization of pulmonary arteriovenous malformations (PAVMs) using a polytetrafluoroethylene-covered microplug compared with embolization using detachable coils. MATERIALS AND METHODS In this prospective study, 37 patients (mean age, 39.1 years [SD ± 17.6]) with 82 PAVMs underwent embolization with microplug or detachable coils between April 2019 and January 2023. Technical success, procedure time intervals, and costs were analyzed. RESULTS In 37 patients, 82 PAVMs and 101 feeding arteries were successfully treated (microplug, 64; microplug + another device, 5; detachable coils alone, 32). Time from embolic device inserted into the catheter to device deployed and time to occlusion differed significantly between microplug and detachable coil cohorts (P < .0001 for both). Embolization with ≥1 microplug had a significantly shorter occlusion time than embolization with detachable coils (median, 10.0 minutes saved per feeding artery) (P < .0001). Compared with detachable coil embolization, microplug embolization saved a median of 9.0 minutes per feeding artery (P < .0001) and reduced room cost by a median of $429 per feeding artery (P < .0001). Device costs per feeding artery did not differ significantly between microplug ($2,790) and detachable coil embolization ($3,147) (P = .87). CONCLUSIONS Compared with coils, microplugs had an equally high technical success rate but significant time to occlusion and room costs savings per feeding artery. Total room cost and device cost together did not differ significantly between microplugs and coils. Microplugs may be considered technically effective and at least cost-neutral for PAVM embolization where clinically appropriate.
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Affiliation(s)
- Anna J Gong
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eugene C Bosworth
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tushar Garg
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Tanaka K, Osuga K, Nagai K, Satomura H, Tomotake K, Koretsune Y, Kimura Y, Ono Y, Higashihara H, Tomiyama N. Four Cases of Delayed Pneumonia Around Coils After Embolization of Pulmonary Arteriovenous Malformations. Cardiovasc Intervent Radiol 2024; 47:397-400. [PMID: 38087054 DOI: 10.1007/s00270-023-03588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/05/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Kaishu Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan.
| | - Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, Japan
| | - Keisuke Nagai
- Department of Radiology, Toyonaka Municipal Hospital, 1-14-4 Shibahara-Cho, Toyonaka, Osaka, Japan
| | - Hiroki Satomura
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Kosuke Tomotake
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yuji Koretsune
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yasushi Kimura
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yusuke Ono
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hiroki Higashihara
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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Botsford A, Tradi F, Loubet A, Tantawi S, Soulez G, Giroux MF, Faughnan ME, Gauthier A, Perreault P, Bouchard L, Holderbaum do Amaral R, Chartrand-Lefebvre C, Therasse E. Transarterial Embolization of Simple Pulmonary Arteriovenous Malformations: Long-Term Outcomes of 0.018-Inch Coils versus Vascular Plugs. J Vasc Interv Radiol 2024; 35:349-360. [PMID: 38013007 DOI: 10.1016/j.jvir.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/24/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To compare the safety, effectiveness, and persistence rates of 0.018-inch coils with those of Amplatzer vascular plugs (AVPs; Abbott Vascular, Abbott Park, Illinois) for the treatment of pulmonary arteriovenous malformations (PAVMs) in response to a growing concern that 0.018-inch coil embolization would increase the long-term persistence rate. MATERIALS AND METHODS This is a retrospective, single-center study of a database (2002-2020) of 633 PAVM embolizations. Complex PAVMs and those not embolized with 0.018-inch coils or plugs were excluded. PAVM embolization material was classified into 4 groups: (a) 0.018-inch nonfibered coils (NFCs), (b) 0.018-inch fibered coils (FCs), (c) NFCs and FCs, or (d) plugs. Persistence was defined as flow through the PAVM on digital subtraction angiography (DSA) or as <30% diameter reduction of the aneurysmal sac on unenhanced computed tomography (CT). Kaplan-Meier analysis and Cox regression were used to assess PAVM's persistence-free survival. RESULTS A total of 312 PAVM embolizations with NFCs (43 PAVMs), FCs (127 PAVMs), NFCs and FCs (12 PAVMs), or plugs (130 PAVMs) in 109 patients (28% men; mean age = 49 years) were included. All PAVM embolizations were technically successful without any major adverse events. PAVM persistence-free survival rates at 10 years' follow-up were 40.8% versus 44.7% in the NFC and FC groups (P = .22) and 47.3% versus 81.0% in the 0.018-inch coil (NFC or FC) and plug groups (P < .0001), respectively. There were 0.43 (79/182) and 0.08 (10/130) re-embolization procedures per PAVM in the 0.018-inch coil and plug groups, respectively (P < .001). CONCLUSIONS PAVM embolization with 0.018-inch coils was safe, but persistence rate with PAVM embolization was significantly higher than that with plugs, with no significant differences between FCs and NFCs.
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Affiliation(s)
- Alexander Botsford
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Department of Radiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Farouk Tradi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Assistance publique-hôpitaux de Marseille, Hôpital de la Timone, Service d'imagerie diagnostic et interventionnelle, Marseille, France; Laboratoire d'imagerie interventionnelle expérimentale (LIIE), Faculté de Médecine, CERIMED, Université Aix-Marseille Marseille, France
| | - Antoine Loubet
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Department of Radiology, Université de Montpellier, France
| | - Suhad Tantawi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Centre de recherche du CHUM (CRCHUM), Pavillon R, Montréal Quebec, Canada
| | - Marie-France Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Marie E Faughnan
- Montreal HHT Centre, Division of Pneumology, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital and Li Ka Shing Knowledge Institute Toronto, Ontario, Canada
| | - Andréanne Gauthier
- Montreal HHT Centre, Division of Pneumology, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada
| | - Pierre Perreault
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Louis Bouchard
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | | | - Carl Chartrand-Lefebvre
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Centre de recherche du CHUM (CRCHUM), Pavillon R, Montréal Quebec, Canada.
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Jiang C, You J, Wang J. Treatment of a Pathologic Radial Fracture Associated with an Arteriovenous Malformation Using Sclerotherapy and Cementoplasty. J Vasc Interv Radiol 2024; 35:318-320.e2. [PMID: 37806349 DOI: 10.1016/j.jvir.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/20/2023] [Accepted: 09/28/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Chunyu Jiang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai 200233, People's Republic of China
| | - Jianxiong You
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai 200233, People's Republic of China
| | - Jingbing Wang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd., Shanghai 200233, People's Republic of China.
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13
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Grill N, Struebing F, Weiss C, Schönberg SO, Sadick M. Management of congenital urogenital and perineal vascular malformations: correlation of clinical findings with diagnostic imaging for treatment decision. ROFO-FORTSCHR RONTG 2024; 196:186-194. [PMID: 37922942 DOI: 10.1055/a-2127-4132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE Analysis of clinical and diagnostic findings in rare urogenital and perineal vascular malformations only occurring in 2-3 % of vascular anomalies with regard to clinical symptoms and treatment decisions. MATERIALS AND METHODS All 25 out of 537 patients presenting with congenital urogenital and perineal vascular malformations at our institution from 2014 to 2021 were included. Vascular anomaly classification, anatomical location, clinical symptoms at presentation, diagnostic imaging, and pain intensity were retrospectively assessed from the patient record and therapy management was evaluated. RESULTS In total, 25 patients (10 females (40 %), 15 males (60 %)), aged 6 to 77 years were included. Diagnoses were: 10 (40 %) venous malformations (VMs), 5 (20 %) lymphatic malformations (LMs) and 10 (40 %) arteriovenous malformations (AVMs). Malformation manifestations were: 12 (32 %) lesser pelvis, 12 (32 %) external genitalia, and 13 (34 %) perineal/gluteal region. One AVM was located in the kidney. The leading clinical symptom was pain. The mean intensity was 6.0/10 for LM, 5.7/10 for VM, and 4.5/10 for AVM. Further major symptoms included physical impairment, local swelling, and skin discoloration. Bleeding complications or sexual dysfunction were rare findings. Patients with VM reported significantly more symptoms than patients with AVM (p = 0.0129). In 13 patients (52 %) minimally invasive therapy was indicated: 10 (77 %) sclerotherapies and 3 (23 %) transcatheter embolization procedures. Complete symptomatic remission was achieved in 9 (69 %) patients, partial response in 3 (23 %) patients, and 1 patient showed no clinical response to therapy. Follow-up appointments without the need for immediate minimally invasive therapy were significantly more common in patients with AVMs than in patients with VMs (p = 0.0198). CONCLUSION To create a higher awareness of congenital urogenital and perineal vascular malformations. Awareness of this rare condition avoids misdiagnosis. Therapy decisions should be symptom-oriented. Emergency intervention is rarely required, even in fast-flow vascular malformations. KEY POINTS · Venous malformations cause more symptoms with higher pain intensity than arteriovenous malformations.. · Diagnosis and adequate treatment can be hampered by a lack of awareness of the clinical presentation.. · Bleeding complications are rare, even in high-flow vascular malformations.. · Pain and physical impairment are the most commonly observed symptoms in these patients..
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Affiliation(s)
- Nadja Grill
- Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
| | - Felix Struebing
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Centre Ludwigshafen, Germany
| | - Christel Weiss
- Department of Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Ruprecht-Karls-University of Heidelberg, Heidelberg, Mannheim, Germany
| | - Stefan O Schönberg
- Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany
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Shaikh A, Khan A, Mohsin F, Haq TU. Fetal choroid plexus arteriovenous malformation, masquerading as a neoplastic lesion. BMJ Case Rep 2024; 17:e258254. [PMID: 38199667 PMCID: PMC10806836 DOI: 10.1136/bcr-2023-258254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
A woman in her 20s, who was pregnant, underwent a routine antenatal ultrasound revealing organised intraventricular haemorrhage and a vascular area in the left thalamic region. Fetal MRI raised suspicion of arteriovenous malformation (AVM). The baby was delivered at 36 weeks via C-section, and initial brain MRI suggested a possible neoplastic lesion.Cerebral angiography confirmed a large AVM involving the left choroid plexus with arterial feeders from the left anterior and posterior choroidal arteries and a large venous varix draining into the vein of Galen. Both arterial feeders were successfully embolised with Onyx and glue, achieving complete occlusion.Choroid plexus AVMs are rare and often lead to intraventricular or intraparenchymal haemorrhage. Surgical treatment has shown success, but endovascular management is effective, especially for small, deep-seated AVMs, offering a better prognosis.
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Affiliation(s)
| | - Anam Khan
- Aga Khan University, Karachi, Pakistan
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15
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Yu Q, Zangan S, Funaki B. Preliminary Experience with a Low-Profile High-Density Braid Occluder for Transcatheter Embolization of Pulmonary Arteriovenous Malformations. J Vasc Interv Radiol 2024; 35:32-35.e2. [PMID: 37748577 DOI: 10.1016/j.jvir.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 09/27/2023] Open
Abstract
This brief report describes safety, technical feasibility, and early treatment effectiveness of the low-profile braided occluder (LOBO; Okami Medical, San Diego, Caliornia) for embolization of 9 pulmonary arteriovenous malformations (PAVMs) in 4 patients (3 female and 1 male; age range: 33 to 63 years; 3 patients showed positive results for hereditary hemorrhagic telangiectasia genes). A total of 10 occluders were deployed in 10 vessels (median treated vessel diameters, 3 and 4 mm for LOBO-3 and LOBO-5 groups, respectively). All devices were successfully deployed into the feeder pulmonary arteries, achieving complete cessation of flow. There were no severe adverse events or device migrations. Available short-term follow-up computed tomography (6 PAVMs: median, 7 months; range, 1.5-7 months) demonstrated complete occlusion without persistence or recanalization. The early experience of embolization of PAVMs using a low-profile braided occluder showed it to be safe and effective. Further studies with larger cohorts and longer follow-up periods are warranted.
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Affiliation(s)
- Qian Yu
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois.
| | - Steven Zangan
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
| | - Brian Funaki
- Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois
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16
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Chaluvashetty SB, Chowhan PS, Bhandari RM, Shah J. Adnexal arteriovenous malformation presenting with spontaneous massive haemoperitoneum. BMJ Case Rep 2023; 16:e254554. [PMID: 38056929 PMCID: PMC10711873 DOI: 10.1136/bcr-2023-254554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Arteriovenous malformations (AVMs) are vascular anomalies composed of a tangle of abnormal vessels in which one or more feeding arteries are directly connected to one or more draining veins via a nidus with no intervening capillary bed. The adnexa are particularly rare sites for the formation of such malformations. Here, we present the case of a middle-aged woman who presented with spontaneous massive haemoperitoneum occurring as a result of a ruptured adnexal AVM. The diagnosis was suspected on transabdominal sonography and confirmed on CT angiography. The patient was shifted to the interventional radiology suite for an urgent angioembolisation following which she improved haemodynamically and her symptoms resolved. The case highlights the fact that although exceedingly rare, gonadal AVMs are an important cause of spontaneous intraperitoneal bleeding. Diagnostic and interventional radiology play an important role in the early and accurate diagnosis of this entity, and angioembolisation can be lifesaving in such patients.
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Affiliation(s)
- Sreedhara B Chaluvashetty
- Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabhjyot Singh Chowhan
- Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajan Mani Bhandari
- Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jimil Shah
- Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Clarençon F, Papagiannaki C, Saleme S, Rouchaud A, Shotar E, Rius E, Burel J, Boch AL, Sourour NA, Mounayer C. Balloon Pressure Technique with the Scepter Mini Balloon as Part of the Endovascular Strategy for Brain Arteriovenous Malformations Embolization : Preliminary Multicenter Experience. Clin Neuroradiol 2023; 33:1055-1065. [PMID: 37401950 DOI: 10.1007/s00062-023-01309-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/16/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The balloon pressure technique (BPT) is an alternative to the pressure cooker technique. A dual lumen balloon (DLB) is used to inject the liquid embolic agent through the working lumen while the balloon is inflated. The purpose of our study was to report our early experience using the Scepter Mini dual lumen balloons for BPT in brain arteriovenous malformation (bAVM) embolization. MATERIAL AND METHODS Consecutive patients treated from July 2020 to July 2021 in 3 tertiary centers using the BPT with low-profile dual lumen balloons (Scepter Mini, Microvention, Tustin, CA, USA) by endovascular means for bAVMs were retrospectively reviewed. Patient demographics and bAVM angio-architectural features were collected. The feasibility of Scepter Mini balloon navigation close to the nidus was evaluated. Technical as well as clinical (ischemic and/or hemorrhagic) complications were also systematically assessed. The occlusion rate was evaluated on follow-up DSA. RESULTS A total of 19 patients (10 females; mean age = 38.2 years) consecutively treated for a bAVM (8 ruptured/11 unruptured) using the BPT with a Scepter Mini through 23 embolization sessions were included in our series. Navigation of the Scepter Mini was feasible in all cases. Of the patients 3 (16%) had procedure-related ischemic stroke and 2 patients (10.5%) had late hemorrhages. None of these complications led to severe permanent sequela. Complete occlusion of bAVM embolized with intention to cure was recorded in 11/13 cases (84.6%). CONCLUSION The BPT using low-profile dual lumen balloons is feasible and seems safe for embolization of bAVMs. It may help to reach high occlusion rates, especially when performed in the intent to cure by embolization only.
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Affiliation(s)
- Frédéric Clarençon
- Sorbonne University, Paris, France.
- GRC BioFast, Sorbonne University, Paris, France.
| | | | - Suzanna Saleme
- Department of Neuroradiology, Limoges University Hospital, Limoges, France
| | - Aymeric Rouchaud
- Department of Neuroradiology, Limoges University Hospital, Limoges, France
- University of Limoges, Limoges, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Bd de l'Hôpital, 75013, Paris, France
| | - Emily Rius
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Bd de l'Hôpital, 75013, Paris, France
| | - Julien Burel
- Department of Radiology, Rouen University Hospital, Rouen, France
| | - Anne-Laure Boch
- Department of Neurosurgery, APHP-Sorbonne University, Paris, France
| | - Nader-Antoine Sourour
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Bd de l'Hôpital, 75013, Paris, France
| | - Charbel Mounayer
- Department of Neuroradiology, Limoges University Hospital, Limoges, France
- University of Limoges, Limoges, France
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18
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Tan I, Toh L. Abnormal uterine bleeding due to uterine arteriovenous malformation in an early adolescent with intrauterine contraceptive device in situ. BMJ Case Rep 2023; 16:e258241. [PMID: 38050399 PMCID: PMC10693851 DOI: 10.1136/bcr-2023-258241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
We report a case of uterine arteriovenous malformation in an early adolescent who presented with heavy vaginal bleeding 2 months after termination of pregnancy with copper intrauterine contraceptive device (IUCD) insertion. The patient was admitted and had medical treatment, including blood transfusion and subsequently transcatheter embolisation of the arteriovenous malformation to control her bleeding. The IUCD was left in situ. Her symptoms completely resolved by 4 months post-procedure.
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Affiliation(s)
- Ilka Tan
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Luke Toh
- Radiology, KK Women's and Children's Hospital, Singapore
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19
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Shen Y, Wang D, Wen M, Di R, Fan X, Su L, Yang X. Coil-assisted ethanol embolotherapy for refractory head and neck arteriovenous malformations with Onyx recrudescence: 10-Year experiences. J Vasc Surg Venous Lymphat Disord 2023; 11:1219-1230. [PMID: 37473869 DOI: 10.1016/j.jvsv.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/29/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE This study aimed to evaluate the outcomes of coil-assisted ethanol embolotherapy in recanalized head and neck arteriovenous malformations (HNAVMs) with dilated outflowing veins after Onyx treatment. METHODS Thirty-six patients with HNAVMs (18 females and 18 males with a mean age of 26.83 years) who experienced recurrence after Onyx embolization from October 2007 to October 2017 were included in this study. All patients underwent complete clinical and angiographic examinations. Further, each patient was classified based on the Schobinger stage before undergoing staged ethanol embolization. All patients were followed up for 5 years in-person at an interval of 3 months after discharge. The Kaplan-Meier method was used to perform the recurrence-free survival analysis. RESULTS Sixteen patients (44.4%) had Schobinger stage II HNAVMs, and the remaining patients had Schobinger stage III or IV (20/36 patients [55.6%]) HNAVMs. A total of 116 embolization procedures were performed, coils were applied in 107 procedures (92.2%) among patients with dilated outflowing veins. The dose of absolute ethanol was 16.39 mL per procedure in patients with Schobinger II HNAVMs, and 22.45 mL per procedure in patients with Schobinger III and IV HNAVMs (P = .024, 95% confidence interval, 1.128-5.009). During the 3-month evaluation, complete response was observed in 13 of 36 patients (36.1%), and partial response was observed in 23 of 36 patients (63.9%). The 5-year recurrence-free survival rate for patients who underwent Onyx treatment had improved 58.3% after ethanol embolization (95% confidence interval, 2.853-9.595; P < .0001). CONCLUSIONS Coil-assisted ethanol embolotherapy could treat refractory HNAVMs with Onyx recrudescence effectively.
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Affiliation(s)
- Yuchen Shen
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Deming Wang
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingzhe Wen
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruoyu Di
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xindong Fan
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lixin Su
- Fengcheng Hospital of Feng Xian District, Fengcheng Branch, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xitao Yang
- Vascular Anomaly Center. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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20
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Yoshida K, Niimi Y, Kamamoto D, Fukumura M, Imai R, Nagoshi N, Akiyama T. Targeted embolisation for coexisting conus medullaris arteriovenous malformation and cauda equina arteriovenous fistulas with a varix on a shared drainer †. Br J Neurosurg 2023; 37:1200-1205. [PMID: 33034527 DOI: 10.1080/02688697.2020.1830948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The coexistence of vascular malformations in the conus medullaris and cauda equina has been rarely reported, and the complex angioarchitecture in multiple arteriovenous lesions remains poorly understood. CASE DESCRIPTION A 17-year-old woman presented with a sudden-onset, stepwise worsening of weakness and pain in the bilateral legs. Angiography revealed conus medullaris arteriovenous malformation and cauda equina arteriovenous fistulas. One of the drainers was shared between the coexisting lesions and harboured a varix. Targeted embolisation of a fistulous point in the conus lesion was performed with precaution to prevent occluding the common drainage route, which led to symptom improvement with angiographical diminishment of the varix. CONCLUSIONS Recognising that communications between drainers can be observed in multiple spinal arteriovenous lesions is important in facilitating a safe embolisation. Cautious assessment of angiogram with fusion images of cone-beam computed tomography and volumetric T2 magnetic resonance imaging can help in establishing the diagnosis and treatment strategy.
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Affiliation(s)
- Keisuke Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Dai Kamamoto
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Mariko Fukumura
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryotaro Imai
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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Pampín Martínez MM, Rodríguez-Laguna L, Gómez García E, Cebrián Carretero JL, González Otero T, López Gutiérrez JC. Genetic Profile of Arteriovenous Anomalies of the Head and Neck: Implications in Progression and Therapeutic Approaches. J Pediatr Surg 2023; 58:2043-2049. [PMID: 36868957 DOI: 10.1016/j.jpedsurg.2023.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/07/2023] [Accepted: 01/08/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Arteriovenous Malformations (AVMs) are complex vascular anomalies that are usually sporadic and can have a variable clinical course. Treatment of AVMs can lead to severe sequeale and require thorough decision-making. There is a lack of standardized treatment protocols showing a growing need for pharmacological targeted therapies, specially in the most severe cases where surgery may not be feasible. Current knowledge in molecular pathways and genetic diagnosis have shed light in the pathophysiology of AVMs, opening possibilities for personalized treatment strategies. METHODS We performed a retrospective review of patients with head and neck AVMs treated in our department between 2003 and 2021 and performed a complete physical examination and imaging with ultrasound and angio-CT or MRI. Patients underwent genetic testing on AVMs' tissue samples and/or peripheral blood samples. Patients were grouped according to the genetic variant and a correlation between phenotype and genotype was studied. RESULTS 22 patients with head and neck AVMs were included. We found eight patients with varians in MAP2K1, four patients with pathogenic variants in KRAS, six patients with pathogenic variants in RASA1, one patient with a pathogenic variant in BRAF, one patient with a pathogenic variant in NF1, another patient with a pathogenic variant in CELSR1 and one patient with pathogenic variants in PIK3CA and GNA14. Patients with MAP2K1 variants were the biggest group, with a moderate clinical course. Patients with KRAS mutations showed the most aggressive clinical course and a high rate of recurrence and osteolysis. Patients with RASA1 variants showed a characteristic phenotype with an ipsilateral capillary malformation in the neck. CONCLUSION We found a correlation between genotype and phenotype in this group of patients. The genetic diagnosis of AVMs is recommended in order to stablish a personalized treatment strategy. Targeted therapies are currently being investigated with promising results and may be recommended in addition to conventional surgical or embolization procedures, specially in the most complex cases. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | - Elena Gómez García
- Oral and Maxillofacial Surgery Department, La Paz University Hospital, Madrid, Spain
| | | | - Teresa González Otero
- Oral and Maxillofacial Surgery Department, La Paz University Hospital, Madrid, Spain
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22
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Tuleja A, Bernhard S, Hamvas G, Andreoti TA, Rössler J, Boon L, Vikkula M, Kammer R, Haupt F, Döring Y, Baumgartner I. Clinical phenotype of adolescent and adult patients with extracranial vascular malformation. J Vasc Surg Venous Lymphat Disord 2023; 11:1034-1044.e3. [PMID: 37030445 DOI: 10.1016/j.jvsv.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVE In recent years, genotypic characterization of congenital vascular malformations (CVMs) has gained attention; however, the spectrum of clinical phenotype remains difficult to attribute to a genetic cause and is rarely described in the adult population. The aim of this study is to describe a consecutive series of adolescent and adult patients in a tertiary center, where a multimodal phenotypic approach was used for diagnosis. METHODS We analyzed clinical findings, imaging, and laboratory results at initial presentation, and set a diagnosis according to the International Society for the Study of Vascular Anomalies (ISSVA) classification for all consecutively registered patients older than 14 years of age who were referred to the Center for Vascular Malformations at the University Hospital of Bern between 2008 and 2021. RESULTS A total of 457 patients were included for analysis (mean age, 35 years; females, 56%). Simple CVMs were the most common (n = 361; 79%), followed by CVMs associated with other anomalies (n = 70; 15%), and combined CVMs (n = 26; 6%). Venous malformations (n = 238) were the most common CVMs overall (52%), and the most common simple CVMs (66%). Pain was the most frequently reported symptom in all patients (simple, combined, and vascular malformation with other anomalies). Pain intensity was more pronounced in simple venous and arteriovenous malformations. Clinical problems were related to the type of CVM diagnosed, with bleeding and skin ulceration in arteriovenous malformations, localized intravascular coagulopathy in venous malformations, and infectious complications in lymphatic malformations. Limb length difference occurred more often in patients with CVMs associated with other anomalies as compared with simple or combined CVM (22.9 vs 2.3%; P < .001). Soft tissue overgrowth was seen in one-quarter of all patients independent of the ISSVA group. CONCLUSIONS In our adult and adolescent population with peripheral vascular malformations, simple venous malformations predominated, with pain as the most common clinical symptom. In one-quarter of cases, patients with vascular malformations presented with associated anomalies on tissue growth. The differentiation of clinical presentation with or without accompanying growth abnormalities need to be added to the ISSVA classification. Phenotypic characterization considering vascular and non-vascular features remains the cornerstone of diagnosis in adult as well as pediatric patients.
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Affiliation(s)
- Aleksandra Tuleja
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Sarah Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Györgyi Hamvas
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Themis-Areti Andreoti
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital - University Hospital of Bern, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Jochen Rössler
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital - University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Laurence Boon
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Saint Luc University Hospital, Brussels, Belgium
| | - Miikka Vikkula
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Saint Luc University Hospital, Brussels, Belgium; Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
| | - Rafael Kammer
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Fabian Haupt
- Department of Radiology, Inselspital, Bern University, Hospital, Bern, Switzerland
| | - Yvonne Döring
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland; Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland; Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University, Hospital, Bern, Switzerland
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Yang WH, Xiang XJ, Li HL. Sclerotherapy for congenital vascular malformations with mixing foam of polidocanol and liquid of bleomycin. Phlebology 2023; 38:451-457. [PMID: 37318342 DOI: 10.1177/02683555231184772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To evaluate the efficacy of sclerotherapy for congenital vascular malformation (CVM) using a combination of polidocanol foam and bleomycin liquid. METHODS A retrospective review of a prospectively collected data on patients who had sclerotherapy for CVM from May 2015 to July 2022 was performed. RESULTS A total of 210 patients with a mean age of 24.8 ± 2.0 years were included. Venous malformation (VM) was the most common type of CVM, accounting for 81.9% (172/210) of all patients. At 6 months follow-up, the overall clinical effective rate was 93.3% (196/210), and 50% (105/210) of patients were clinically cured. The clinical effective rates in VM, lymphatic, and arteriovenous malformation group were 94.2%, 100%, and 100%. CONCLUSION Sclerotherapy using a combination of polidocanol foam and bleomycin liquid is an effective and safe treatment for venous and lymphatic malformations. It is a promising treatment option with satisfactory clinical outcome in arteriovenous malformations.
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Affiliation(s)
- Wei-Hong Yang
- Department of Interventional Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xian-Jun Xiang
- Department of Interventional Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Nusca A, Viscusi MM, Ussia GP. Double anterograde/retrograde approach for embolization of pulmonary arteriovenous malformation presenting with acute respiratory failure. Eur Heart J 2023; 44:2348. [PMID: 36806935 DOI: 10.1093/eurheartj/ehad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- Annunziata Nusca
- Department of Cardiovascular Sciences, Campus Bio-Medico University, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Michele Mattia Viscusi
- Department of Cardiovascular Sciences, Campus Bio-Medico University, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Gian Paolo Ussia
- Department of Cardiovascular Sciences, Campus Bio-Medico University, Via Alvaro del Portillo 200, Rome 00128, Italy
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Su L, Yang X, Wang Z, Wen M, Fan X, Wang D. Eradication of the nidus in arteriovenous malformations with a dominant outflow vein in the lower extremities using coils and absolute ethanol. J Vasc Surg Venous Lymphat Disord 2023; 11:809-815. [PMID: 37076100 DOI: 10.1016/j.jvsv.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 04/21/2023]
Abstract
OBJECTIVE In the present study, we summarize our experience in locating the nidus of arteriovenous malformations (AVMs) with a dominant outflow vein (DOV) in the lower extremities and eradicating the nidus with ethanol and coils. METHODS Twelve patients with lower extremity AVMs who underwent ethanol embolization combined with DOV occlusion from January 2017 to May 2018 were enrolled in the present study. Selective angiography was used to locate the nidus of the AVMs, which was eradicated using ethanol and coils via the direct puncture pathway. All treated patients underwent postoperative follow-up (mean, 25.5 months; range, 14-37 months). RESULTS The 12 patients underwent a total of 29 procedures (mean, 2.4; range, 1-4) with 27 detachable coils and 169 Nester coils (Cook Medical Inc, Bloomington, IN). Of the 12 patients, 7 (58.3%) had a complete response and 5 (41.7%) a partial response. Three patients (25%) had minor complications such as blister and superficial skin ulcers during follow-up. However, they recovered spontaneously and completely. No major complications were recorded. CONCLUSIONS Ethanol embolization combined with coil-assisted DOV occlusion has the potential to eradicate the nidus of lower extremity AVMs with acceptable complication rates.
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Affiliation(s)
- Lixin Su
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xitao Yang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenfeng Wang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingzhe Wen
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xindong Fan
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Deming Wang
- Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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26
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Li X, Fan XD, Wang DM, Yang XT, Su LX. [Clinical analysis of interventional embolization for 9 cases with frontal arteriovenous malformation]. Shanghai Kou Qiang Yi Xue 2023; 32:332-336. [PMID: 37803994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
PURPOSE To investigate the efficacy and safety of interventional embolization in the treatment of frontal arteriovenous malformation (AVM). METHODS A retrospective study was used to analyze 9 patients with frontal AVM who were treated in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The patients were treated with interventional embolization under the guidance of DSA. The scope of lesions was observed through DSA, and the injection dose of sclerosing agent was predicted so that the drug could be injected into the lesion cavity. The efficacy, adverse reactions and complications of all patients were observed and analyzed. RESULTS Among the 9 patients, there were 7 males(77.8%) and 2 females(22.2%), aged from 1.5-20 years old. Local swelling or mass was the main reported symptom(66.7%). The blood supply arteries of the cases involved in this study included superficial temporal artery and ophthalmic artery. All patients received interventional embolization treatment under general anesthesia, a total of 19 times (each patient received 1-6 times, average 2.1 times/person), and the average single dose of absolute ethanol was 9.0 mL. A total of 80 coils (4.2 coils/time on average) were used for 5 times (80 coils/19 times) with absolute ethanol embolization. In addition, bleomycin was used 3 times, pingyangmycin was used 2 times, and 3% polydocanol was used 1 time to assist embolization. Among the 9 cases included in this study, 4 cases were cured, 3 cases were basically cured, 2 cases were improved, and the effective rate of treatment was 100%. No local or systemic complications were reported in all patients. CONCLUSIONS In the treatment of frontal arteriovenous malformation, correct diagnosis according to clinical and imaging manifestations, and interventional embolization with anhydrous ethanol according to DSA angiography results can reduce trauma, improve symptoms, control lesions, and obtain relatively satisfactory treatment results. This scheme is safe and effective.
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Affiliation(s)
- Xiao Li
- The 2nd Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology. Shanghai 200011, China. E-mail:
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Nakai N, Ichiba T, Hata M, Okazaki Y. CT chest-cerebral angiography for basilar artery occlusion caused by pulmonary arteriovenous malformation. BMJ Case Rep 2023; 16:e253215. [PMID: 37130634 PMCID: PMC10163420 DOI: 10.1136/bcr-2022-253215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Early diagnosis of basilar artery occlusion (BAO) based only on clinical findings is challenging. We present a fully recovered case of BAO caused by pulmonary arteriovenous malformation (PAVM) that was diagnosed early using a protocol for CT angiography (CTA) and promptly treated with endovascular therapy (EVT). A woman in her 50s complained of vertigo with normal level of consciousness (LOC). On arrival, her LOC decreased to a Grass Coma Scale score of 12, and we performed a CT chest-cerebral angiography protocol. Head CTA showed BAO, and an intravenous tissue plasminogen activator was administered, followed by EVT. Chest contrast-enhanced CT showed PAVM in segment 10 of the left lung, which was treated with coil embolisation. For patients with a complaint of vertigo, BAO should be suspected, even if they have an initially normal LOC. A CT chest-cerebral angiography protocol is useful for prompt diagnosis and treatment of BAO and can reveal undetermined causes.
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Affiliation(s)
- Natsumi Nakai
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Toshihisa Ichiba
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Masako Hata
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Yuji Okazaki
- Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
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Kulkarni CB, Sutphin P, Iqbal S, Kalva SP. Diagnosis and Management of Persistent Pulmonary Arterio-venous Malformations following Embolotherapy. Acad Radiol 2023; 30:441-452. [PMID: 36089478 DOI: 10.1016/j.acra.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 01/25/2023]
Abstract
Embolotherapy is the primary treatment for pulmonary arterio-venous malformations (PAVMs). Approximately, 2-25% of PAVMs demonstrate persistence following embolization. Early identification and treatment of persistent PAVMs are critical to mitigating life threatening complications. The presence of prior embolic devices and complex angioarchitecture of persistent PAVMs pose technical challenges during repeat embolotherapy. In this article, we review patterns of persistence, factors affecting the persistence, endovascular treatment techniques, and outcomes.
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Affiliation(s)
- Chinmay Bhimaji Kulkarni
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India.
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Nakamura T, Yabuta M, Kitamura A, Jinta T. Giant complex pulmonary arteriovenous malformation treated with coil embolisation under general anaesthesia with a history of contrast media allergy. BMJ Case Rep 2023; 16:e254148. [PMID: 36810332 PMCID: PMC9945137 DOI: 10.1136/bcr-2022-254148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- Tomoaki Nakamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Minoru Yabuta
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Atsushi Kitamura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Torahiko Jinta
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
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30
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Shoji MK, Tran AQ, Lee WW, Dubovy S, Kossler A. Ophthalmic artery occlusion following n-butyl cyanoacrylate embolization of an orbital arteriovenous malformation. Orbit 2023; 42:87-93. [PMID: 34365893 PMCID: PMC10954302 DOI: 10.1080/01676830.2021.1955937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/10/2021] [Indexed: 01/28/2023]
Abstract
A 33-year-old pregnant woman presented with six months of right-sided proptosis. Neuroimaging revealed a right orbital arteriovenous malformation arising from the second segment of the ophthalmic artery. As she was 9 weeks pregnant, the decision was made to monitor her closely. Over the following six months, her proptosis progressed, accompanied by decreased visual acuity, afferent pupillary defect, and red desaturation concerning for compressive optic neuropathy. After planned c-section, she underwent embolization with n-butyl cyanoacrylate. Upon awakening after embolization, she had no light perception vision from her right eye and was found to have ophthalmic artery obstruction. She ultimately developed a blind painful right eye and underwent enucleation with histopathology demonstrating glue in the central retinal artery, posterior ciliary arteries, and choroid. This case highlights ophthalmic artery occlusion as a rare complication of orbital arteriovenous malformation embolization and demonstrates correlating histopathological findings, which have not previously been reported.
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Affiliation(s)
- Marissa K. Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | - Ann Q. Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Northwell Health, New York, NY
| | - Wendy W. Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | - Sander Dubovy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | - Andrea Kossler
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA
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Jogo A, Yamamoto A, Mukai K, Kageyama K, Kaminou T, Miki Y. Transportal Balloon-Occluded Retrograde Transvenous Obliteration for a Pancreatic Arteriovenous Malformation Using the Outflow Debranching Technique. J Vasc Interv Radiol 2023; 34:927-931. [PMID: 36603768 DOI: 10.1016/j.jvir.2022.12.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Atsushi Jogo
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Kaori Mukai
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Ken Kageyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Toshio Kaminou
- Advanced Imaging and Minimally Invasive Therapy Center, Tsukazaki Hospital, Himeji, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Abdelrady M, Dargazanli C, Derraz I, Cagnazzo F, Costalat V. Successful WEBectomy during embolization of temporal arteriovenous malformation-associated flow-related basilar aneurysms. Interv Neuroradiol 2022; 28:644-649. [PMID: 34775869 PMCID: PMC9706264 DOI: 10.1177/15910199211057693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Intra-procedural WEB device migration is a scarcely reported complication that necessitates prompt intervention. CASE PRESENTATION Endovascular treatment of two broad necked flow-related aneurysms was planned aided by WEB-SL (Woven EndoBridge-single layer) devices in a 71-year-old female with known left temporal arteriovenous malformation. Inadvertent distal migration occurred while performing a control angiogram with an automated iodine injector. Immediate retrieval was successfully performed using a Solitaire stent-retriever. CONCLUSION To our knowledge, we report for the first time the successful retrieval of a distally migrated WEB using a stent-retriever device.
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Affiliation(s)
- Mohamed Abdelrady
- Interventional Neuroradiology Unit, Ain Shams University hospitals, Cairo, Egypt
| | - Cyril Dargazanli
- Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalo-Universitaire de
Montpellier, Montpellier, France
| | - Imad Derraz
- Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalo-Universitaire de
Montpellier, Montpellier, France
| | - Federico Cagnazzo
- Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalo-Universitaire de
Montpellier, Montpellier, France
| | - Vincent Costalat
- Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalo-Universitaire de
Montpellier, Montpellier, France
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Prasad SN, Sharma S, Singh V, Phadke RV. Endovascular management of pulmonary arteriovenous malformations presenting as multiple brain abscesses. BMJ Case Rep 2022; 15:e251593. [PMID: 36414347 PMCID: PMC9685250 DOI: 10.1136/bcr-2022-251593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pulmonary arteriovenous malformations (PAVMs) are rare vascular lesions characterised by abnormal connections between the pulmonary artery and vein bypassing the pulmonary capillary bed and causing right-to-left shunt. Paradoxical embolism is known to occur in these cases, leading to inoculation of septic focus in the systemic circulation. We report a case of multiple PAVMs who presented clinically with seizures and altered sensorium. On radiological work-up, multiple brain abscesses and large PAVMs were evident. The patient was successfully treated by endovascular embolisation of the PAVMs using a vascular plug and multiple coils. The patient showed complete clinical recovery and resolution of brain abscesses on follow-up.
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Affiliation(s)
- Surya Nandan Prasad
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Srishti Sharma
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vivek Singh
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajendra Vishnu Phadke
- Radiodiagnosis & Interventional Radiology, Apollomedics Super Speciality Hospitals, Lucknow, Uttar Pradesh, India
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Shin YM, Kim Y, Yang J, Yang B, Choi IA, Lee KM. Recurrent pulmonary arteriovenous malformation in a patient with Sjögren syndrome: A case report. Medicine (Baltimore) 2022; 101:e30954. [PMID: 36254021 PMCID: PMC9575738 DOI: 10.1097/md.0000000000030954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Pulmonary manifestations of Sjögren syndrome (SS) are variable and may involve the airway or lung parenchyma and increase the risk of vascular and malignant disease. However, to date, only one case of pulmonary arteriovenous malformation (AVM) has been reported in a patient with SS. Here, we report a rare case of recurrent pulmonary AVMs with aggravating multiple cysts in a patient with SS during a period of 14 years. PATIENT CONCERNS A 45-year-old woman was diagnosed with SS and pulmonary AVM in the right lung. Her AVMs were embolized successfully and she was followed up annually for 14 years. Eleven years after the initial treatment, her chest computed tomography showed new pulmonary AVMs in the left lung with aggravating multiple cysts. DIAGNOSIS We diagnosed her with SS according to the American-European consensus group criteria of 2010. Chest computed tomography and angiographic findings confirmed the recurrence of pulmonary AVMs. INTERVENTIONS The patient's recurrent pulmonary AVMs were successfully treated by embolization. OUTCOMES Although her multiple cystic lung lesions had been aggravating during 14 years, she received embolization for the pulmonary AVMs twice and developed no complication related to these procedures. Currently, the patient is 56 years old and still alive with good performance state. LESSONS To date, only one case of pulmonary AVM has been reported in a patient with SS. The patient died 2.5 years after the diagnosis without recurrence of AVM. Here, we present a rare case of recurrent pulmonary AVMs associated with aggravating multiple cysts in both lungs, which were observed during long-term follow-up, in a patient with SS.
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Affiliation(s)
- Yoon Mi Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Yook Kim
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jiyoul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - In Ah Choi
- Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ki Man Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- * Correspondence: Ki Man Lee, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 776 1Sunhwan-ro, Seowon-gu, Cheongju 28644, Republic of Korea (e-mail: )
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Ciccarese F, Chauvel-Picard J, Guibaud L, Viremouneix L, Perrot JL, Breton P, Gleizal A. Management of intra-osseous arteriovenous malformations of the mandible. J Stomatol Oral Maxillofac Surg 2022; 123:e544-e548. [PMID: 35272090 DOI: 10.1016/j.jormas.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Intra-mandibular arteriovenous malformations (IM-AVM) are rare congenital lesions sadly known by the appearance of cataclysmic haemorrhages. It represents a therapeutic challenge which requires a multidisciplinary approach. This paper aims to evaluate the characteristics and management of IM-AVM through the illustration of six case reports, the largest serie in the literature to our knowledge. This retrospective study included all patients with IM-AVM treated in the hospital of Lyon and Saint-Etienne between 1982 and 2021, in France. The management of mandibular AVMs should be individualized and permanently adjusted according to their stage of development, which makes their management difficult. Furthermore, long-term follow-up is essential to detect and manage the subclinical progression of the lesion. Based on these results and a systematic review of the literature, an algorithm has been developed to guide the treatment strategy for this are pathology.
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Affiliation(s)
- Fanny Ciccarese
- Department of Cranio-Maxillo-Facial Surgery, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France; Jacques Lisfranc faculty of Medicine, Jean Monnet University, Saint-Etienne, France.
| | - Julie Chauvel-Picard
- Department of Cranio-Maxillo-Facial Surgery, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France; Jacques Lisfranc faculty of Medicine, Jean Monnet University, Saint-Etienne, France; Department of Cranio-Maxillo-Facial Surgery of the pediatric hospital, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69677 Bron, France
| | - Laurent Guibaud
- Department of Pedriatric and Fetal Imaging, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69500 Bron, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
| | - Loïc Viremouneix
- Department of Pedriatric and Fetal Imaging, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69500 Bron, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
| | - Jean-Luc Perrot
- Jacques Lisfranc faculty of Medicine, Jean Monnet University, Saint-Etienne, France; Department of dermatology, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France
| | - Pierre Breton
- Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France; Department of Cranio-Maxillo-Facial Surgery, Centre Hospitalier Lyon Sud, 165 chemin du Grand Revoyet, 69310 Pierre-Bénite, France
| | - Arnaud Gleizal
- Department of Cranio-Maxillo-Facial Surgery, Hôpital Nord, Avenue Albert Raimond 42055 Saint-Etienne Cedex, France; Department of Cranio-Maxillo-Facial Surgery of the pediatric hospital, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69677 Bron, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
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Sredoja Tišma VS, Vlašić A, Gulin P, Huzjan Korunić R. The Importance of a Multidisciplinary Approach in a Patient with Long-term Multisystemic Manifestations of Unrecognized Hereditary Hemorrhagic Telangiectasia. Acta Dermatovenerol Croat 2022; 30:94-98. [PMID: 36254541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Hereditary hemorrhagic telangiectasia (HHT), also called Rendu-Osler-Weber syndrome, is a rare autosomal dominant multisystemic vascular disorder, characterized by widespread mucocutaneous teleangiectasias, frequent visceral arteriovenous malformations (AVM) and a tendency for bleeding. This diagnosis should be suspected in all dermatological patients with generalized mucocutaneous vascular lesions at sites of predilection, associated frequent epistaxis and a positive family history. The aim of this paper is to emphasize the importance of a multidisciplinary approach, the role and timely cooperation of dermatologists and otorhinolaryngologists in the early clinical recognition and diagnosis of the disease. We present a family case of a 63-year - old patient with typical clinical features of HHT and long-standing multisystemic complications of unrecognized disease.
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Tai MZ, Chen T, Ge CX, Xu ZG, Li KL, Qin ZP. [Treatment effects of sandwich-shaped resection and cheiloplasty applied in macrocheilia secondary to arteriovenous malformations]. Zhonghua Yi Xue Za Zhi 2022; 102:1771-1774. [PMID: 35705482 DOI: 10.3760/cma.j.cn112137-20211231-02940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To summarize the clinical experience of sandwich-shaped resection and cheiloplasty in the treatment of macrocheilia secondary to arteriovenous malformation, and to observe its clinical efficacy and complications. The clinical data of 27 patients with macrocheilia secondary to arteriovenous malformation who received surgical treatment from January 2018 to October 2020 in Linyi Cancer Hospital were retrospectively analyzed. There were 14 males and 13 females. The median age was 4.5 years (ranged from 2 to 57 years). There were 18 cases of upper lip and 9 cases of lower lip. All patients had received interventional embolization sclerotherapy for 5 to 10 times before surgery with unsatisfied effect. There was no obvious improvement in the appearance,whereas 3 cases progressed presenting as abnormal enlargement. Sandwich-shaped resection and cheiloplasty was performed in all the patients. Histopathological examinations confirmed arteriovenous malformations in all 27 cases. Twenty-six patients received one course of operation and one received two courses. Partial mucosal necrosis occurred in 1 case and healed after dressing change, while the rest healed by first intention. Local recurrence occurred in 2 cases within 6 months after operation. A four-level standard was used for long-term evaluation, and 24 cases got grade Ⅲ (good), three cases got grade Ⅱ (moderate) after 1 to 3 years of follow-up. Sandwich-shaped resection and cheiloplasty can achieve good long-term efficacy with excellent appearance and function. Due to its advantages of hidden incision and three-dimensional resection and reservation, it is worthy of further clinical promotion.
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Affiliation(s)
- M Z Tai
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi 276001, China
| | - T Chen
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi 276001, China
| | - C X Ge
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi 276001, China
| | - Z G Xu
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi 276001, China
| | - K L Li
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi 276001, China
| | - Z P Qin
- Special Department of Vascular Anomalies, Linyi Cancer Hospital, Linyi 276001, China
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Schmidt VF, Masthoff M, Brill R, Sporns PB, Köhler M, Schulze-Zachau V, Takes M, Ehrl D, Puhr-Westerheide D, Kunz WG, Shemwetta MD, Mbuguje EM, Naif AA, Sarkar A, Ricke J, Seidensticker M, Wohlgemuth WA, Wildgruber M. Image-Guided Embolotherapy of Arteriovenous Malformations of the Face. Cardiovasc Intervent Radiol 2022; 45:992-1000. [PMID: 35655034 PMCID: PMC9226106 DOI: 10.1007/s00270-022-03169-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/05/2022] [Indexed: 12/16/2022]
Abstract
Purpose To evaluate the safety and outcome of image-guided embolotherapy of extracranial arteriovenous malformations (AVMs) primarily affecting the face. Materials and Methods A multicenter cohort of 28 patients presenting with AVMs primarily affecting the face was retrospectively investigated. Fifty image-guided embolotherapies were performed, mostly using ethylene–vinyl alcohol copolymer-based embolic agents. Clinical and imaging findings were assessed to evaluate response during follow-up (symptom-free, partial relief of symptoms, no improvement, and progression despite embolization), lesion devascularization (total, 100%; substantial, 76–99%; partial, 51–75%; failure, < 50%; and progression), and complication rates (classified according to the CIRSE guidelines). Sub-analyses regarding clinical outcome (n = 24) were performed comparing patients with (n = 12) or without (n = 12) subsequent surgical resection after embolotherapy. Results The median number of embolotherapy sessions was 2.0 (range, 1–4). Clinical outcome after a mean follow-up of 12.4 months (± 13.3; n = 24) revealed a therapy response in 21/24 patients (87.5%). Imaging showed total devascularization in 14/24 patients (58.3%), including the 12 patients with subsequent surgery and 2 additional patients with embolotherapy only. Substantial devascularization (76–99%) was assessed in 7/24 patients (29.2%), and partial devascularization (51–75%) in 3/24 patients (12.5%). Complications occurred during/after 12/50 procedures (24.0%), including 18.0% major complications. Patients with subsequent surgical resections were more often symptom-free at the last follow-up compared to the group having undergone embolotherapy only (p = 0.006). Conclusion Image-guided embolotherapy is safe and effective for treating extracranial AVMs of the face. Subsequent surgical resections after embolization may substantially improve patients’ clinical outcome, emphasizing the need for multimodal therapeutic concepts. Level of Evidence Level 4, Retrospective study. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-022-03169-0.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Peter B Sporns
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Köhler
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Victor Schulze-Zachau
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Takes
- Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Denis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Mwivano Dunstan Shemwetta
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eric M Mbuguje
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Azza A Naif
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Abizer Sarkar
- Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Egashira Y, Azama S, Nojiri J, Takeshita G, Irie H. Embolization of renal arteriovenous malformation using double-balloon catheter. J Vasc Interv Radiol 2022; 33:1006-1008. [PMID: 35490931 DOI: 10.1016/j.jvir.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/30/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yoshiaki Egashira
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Shinya Azama
- Department of Radiology, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Junichi Nojiri
- Department of Radiology, Medical Corporation Kouhoukai, Takagi Hospital, Fukuoka, Japan
| | - Go Takeshita
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Franzetti G, Bonfanti M, Tanade C, Lim CS, Tsui J, Hamilton G, Díaz-Zuccarini V, Balabani S. A Computational Framework for Pre-Interventional Planning of Peripheral Arteriovenous Malformations. Cardiovasc Eng Technol 2022; 13:234-246. [PMID: 34611845 PMCID: PMC9114032 DOI: 10.1007/s13239-021-00572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/26/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE Peripheral arteriovenous malformations (pAVMs) are congenital lesions characterised by abnormal high-flow, low-resistance vascular connections-the so-called nidus-between arteries and veins. The mainstay treatment typically involves the embolisation of the nidus, however the complexity of pAVMs often leads to uncertain outcomes. This study aims at developing a simple, yet effective computational framework to aid the clinical decision making around the treatment of pAVMs using routinely acquired clinical data. METHODS A computational model was developed to simulate the pre-, intra-, and post-intervention haemodynamics of a patient-specific pAVM. A porous medium of varying permeability was employed to simulate the sclerosant effect on the nidus haemodynamics. Results were compared against clinical data (digital subtraction angiography, DSA, images) and experimental flow-visualization results in a 3D-printed phantom of the same pAVM. RESULTS The computational model allowed the simulation of the pAVM haemodynamics and the sclerotherapy-induced changes at different interventional stages. The predicted inlet flow rates closely matched the DSA-derived data, although the post-intervention one was overestimated, probably due to vascular system adaptations not accounted for numerically. The nidus embolization was successfully captured by varying the nidus permeability and increasing its hydraulic resistance from 0.330 to 3970 mmHg s ml-1. The nidus flow rate decreased from 71% of the inlet flow rate pre-intervention to 1%: the flow completely bypassed the nidus post-intervention confirming the success of the procedure. CONCLUSION The study demonstrates that the haemodynamic effects of the embolisation procedure can be simulated from routinely acquired clinical data via a porous medium with varying permeability as evidenced by the good qualitative agreement between numerical predictions and both in vivo and in vitro data. It provides a fundamental building block towards a computational treatment-planning framework for AVM embolisation.
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Affiliation(s)
- Gaia Franzetti
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Mirko Bonfanti
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, 43-45 Foley Street, London, W1W 7TS, UK
| | - Cyrus Tanade
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Chung Sim Lim
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Division of Surgery & Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, Royal Free Campus, Pond Street, London, NW3 2QG, UK
| | - Janice Tsui
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Division of Surgery & Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, Royal Free Campus, Pond Street, London, NW3 2QG, UK
| | - George Hamilton
- Department of Vascular Surgery, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Division of Surgery & Interventional Science, Department of Surgical Biotechnology, Faculty of Medical Sciences, University College London, Royal Free Campus, Pond Street, London, NW3 2QG, UK
| | - Vanessa Díaz-Zuccarini
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, 43-45 Foley Street, London, W1W 7TS, UK.
| | - Stavroula Balabani
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, 43-45 Foley Street, London, W1W 7TS, UK.
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41
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Zainudin Z, Azlisham N, Koh GT, Ooi YK, Nunis MA. Pulmonary arteriovenous malformations: A case of missed diagnosis in a neonate. Med J Malaysia 2022; 77:274-276. [PMID: 35338645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pulmonary arteriovenous malformation (PAVM) is a congenital vascular abnormality that can cause persistent cyanosis in children. PAVMs can go undetected till adulthood; however, there have been several neonatal cases reported over the years. This case report describes a classical manifestation of a child with isolated PAVM whose diagnosis was likely missed during the neonatal period. A high level of clinical awareness of this condition is crucial as early diagnosis and appropriate treatment can prevent lifethreatening complications and mortality. Diagnosis was confirmed by computed tomography pulmonary angiography and percutaneous transcatheter embolotherapy resulted in complete resolution of symptoms.
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Affiliation(s)
- Z Zainudin
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Paediatrics, Serdang, Selangor, Malaysia
| | - N Azlisham
- Hospital Pakar Sultanah Fatimah, Department of Paediatrics, Malaysia
| | - G T Koh
- Hospital Serdang, Department of Paediatrics, Malaysia
| | - Y K Ooi
- Hospital Serdang, Department of Paediatrics, Malaysia
| | - M A Nunis
- Hospital Serdang, Department of Paediatrics, Malaysia.
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Goto C, Yatsu S, Wada H, Suwa S. Venous thrombosis via pulmonary arteriovenous malformation causing acute myocardial infarction in a relatively young female patient. BMJ Case Rep 2022; 15:15/2/e247846. [PMID: 35228242 PMCID: PMC8886400 DOI: 10.1136/bcr-2021-247846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pulmonary arteriovenous malformation (PAVM) is a probable cause of thromboembolic diseases such as acute myocardial infarction (MI); however, few cases have been reported. A woman in her early 40s developed acute-onset chest pain; an ECG showed ST-elevated MI. Emergency catheter angiography showed that the culprit lesion was a thrombus that was treated successfully with aspiration. She had a history of deep venous thrombosis and CT revealed PAVM. It was likely that the venous thrombus had moved into the coronary artery through the PAVM. Catheter embolisation of the PAVM was performed and she did not experience any other cardiac event until 6 months after embolisation.
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Affiliation(s)
- China Goto
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
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Ciftci E, Cakir O, Yucel Cicek OS, Cam I. Selective Arterial Embolisation of Uterine Arteriovenous Malformation in an Infertile Patient, subsequent Term Pregnancy and Postpartum Recurrence. J Coll Physicians Surg Pak 2022; 32:239-241. [PMID: 35108800 DOI: 10.29271/jcpsp.2022.02.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/09/2020] [Indexed: 06/14/2023]
Abstract
Uterine arteriovenous malformation (AVM) is a rare entity. This report describes selective catheterisation and embolisation of a uterine AVM in an infertile woman, subsequent spontaneous pregnancy and postpartum recurrence of the AVM treated with a second embolisation procedure. A 22-year woman presented with menometrorrhagia and failure to conceive. Pelvic magnetic resonance imaging showed a large uterine AVM. Selective catheterisation and embolisation of the AVM was performed. The patient conceived spontaneously two months later and delivered vaginally. A second embolisation was performed due to recurrence of uterine AVM at six months postpartum. This is the first case reporting postpartum recurrence of a pre-conceptionally treated uterine AVM. Selective catheterisation and embolisation is a minimally-invasive, fertility-preserving procedure that successfully treats uterine AVM and should be the treatment of choice when the patient desires pregnancy. Successful pregnancy and vaginal delivery following embolisation is possible; however, an increased awareness of postpartum AVM recurrence is required. Key Words: Fertility, Pregnancy, Therapeutic embolisation, Uterus, Arteriovenous malformation.
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Affiliation(s)
- Ercument Ciftci
- Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ozgur Cakir
- Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ozge Senem Yucel Cicek
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Isa Cam
- Department of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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44
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Gao F, Ma X, Xu Y, Fu L, Guo X. Management of acquired uterine arteriovenous malformation associated with retained products of conception. J Vasc Interv Radiol 2022; 33:547-553. [PMID: 35093540 DOI: 10.1016/j.jvir.2022.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/09/2021] [Accepted: 01/18/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of different treatments for acquired uterine arteriovenous malformation associated with retained products of conception (UAVM-RPOC) and investigate the role of uterine artery embolization (UAE) in acquired UAVM-RPOC. MATERIALS AND METHODS This was a retrospective study of consecutive patients who presented with UAVM by ultrasound after recent termination pregnancy. 48 patients were included in this study, divided into two groups (massive and minor bleeding groups) according to vaginal bleeding. The treatments were analyzed between groups. Technical and clinical success of UAE was analyzed. RESULTS Of the 48 patients, 11 patients were in the massive bleeding group, and 37 were in the minor bleeding group. 5 patients were referred for UAE in each group, and UAE was a priority for patients with unstable hemodynamics (chi-square value=5.524, p=0.022). Conservative management, dilation and curettage (D&C), operative hysteroscopy, and UAE were performed in 16 (33%), 18 (38%), 7 (15%) and 13 (27%) patients, respectively. Two patients following ectopic pregnancy suffered uncontrollable bleeding during D&C and required UAE. Three patients underwent UAE before surgery to prevent hemorrhage. The technical and clinical success rate of UAE was 100%. No complications or recurrence occurred. CONCLUSION UAE is a safe and effective treatment for UAVM-RPOC and a priority for patients with unstable hemodynamics. Conservative management, D&C and hysteroscopy are safe and effective for UAVM-RPOC patients with stable hemodynamics. However, UAVM-RPOC following ectopic pregnancy may have high risks of massive hemorrhage during procedures.
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Affiliation(s)
- Feng Gao
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xinwen Ma
- Department of Oncology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yali Xu
- Department of Radiology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Le Fu
- Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoqing Guo
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
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Guedes HJ, Kuramoto DAB, Correia RM, Santos BC, Borges ADC, Pereda MR, Aidar ALES, Pereira FA, Amaral FCDF, de Vasconcelos VT, Lustre WG, de Amorim JE, Flumignan RLG, Nakano LCU, Baptista-Silva JCC. What do Cochrane systematic reviews say about congenital vascular anomalies and hemangiomas? A narrative review. SAO PAULO MED J 2022; 140:320-327. [PMID: 35293939 PMCID: PMC9610242 DOI: 10.1590/1516-3180.2021.0374.r2.15092021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/15/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Congenital vascular anomalies and hemangiomas (CVAH) such as infantile hemangiomas, port-wine stains and brain arteriovenous malformations (AVMs) impair patients' lives and may require treatment if complications occur. However, a great variety of treatments for those conditions exist and the best interventions remain under discussion. OBJECTIVE To summarize Cochrane systematic review (SR) evidence on treatments for CVAH. DESIGN AND SETTING Review of SRs conducted in the Division of Vascular and Endovascular Surgery of Universidade Federal de São Paulo, Brazil. METHODS A broad search was conducted on March 9, 2021, in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed treatments for CVAH. The key characteristics and results of all SRs included were summarized and discussed. RESULTS A total of three SRs fulfilled the inclusion criteria and were presented as a qualitative synthesis. One SR reported a significant clinical reduction of skin redness by at least 20%, with more pain, among 103 participants with port-wine stains. One SR reported that propranolol improved the likelihood of clearance 13 to 16-fold among 312 children with hemangiomas. One SR reported that the relative risk of death or dependence was 2.53 times greater in the intervention arm than with conservative management, among 218 participants with brain AVMs. CONCLUSION Cochrane reviews suggest that treatment of port-wine stains with pulsed-dye laser improves redness; propranolol remains the best option for infantile hemangiomas; and conservative management seems to be superior to surgical intervention for treating brain AVMs.
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Affiliation(s)
- Henrique Jorge Guedes
- MD, PhD. Adjunct Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Danielle Akemi Bergara Kuramoto
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Rebeca Mangabeira Correia
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Brena Costa Santos
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Amanda da Cunha Borges
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Mariana Raffo Pereda
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Ana Laura e Silva Aidar
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Francisco Amadeu Pereira
- MD. Resident, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Fabio Cabral de Freitas Amaral
- MD. Postgraduate Student, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Vladimir Tonello de Vasconcelos
- MD, PhD. Adjunct Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Wellington Gianoti Lustre
- MD, MSc. Assistant Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Jorge Eduardo de Amorim
- MD, PhD. Adjunct Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Ronald Luiz Gomes Flumignan
- MD, PhD. Full Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Luis Carlos Uta Nakano
- MD, PhD. Full Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - José Carlos Costa Baptista-Silva
- MD, PhD. Full Professor, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
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Choi SK, Min GE, Lee DG. Congenital Renal Arteriovenous Malformation: Diagnostic Clues and Methods. Medicina (B Aires) 2021; 57:medicina57121304. [PMID: 34946250 PMCID: PMC8706812 DOI: 10.3390/medicina57121304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background and objectives: Renal arteriovenous malformation (AVM) is a rare disease and is difficult to be diagnosed by conventional methods because of its rarity. In this study, we investigated the diagnostic clues, and made an algorithm for the better diagnosis of renal AVM. Materials and Methods: We reviewed 13 patients who were diagnosed with AVM by using renal angiography from 1986 to 2020 at our institutes. We evaluated clinical features, diagnostic tools, treatment modalities, and outcomes after the treatment of patients. Results: All patients were female, and the mean age was 36.9 years (range 19 to 54 years). Twelve (92.3%) patients complained of gross hematuria. Four (30.8%) patients showed symptoms in relation with pregnancy and delivery. Angiographic findings demonstrated cirsoid type in 10 patients and aneurysmal type in 3 patients. Among the 11 patients who underwent computed tomography, AVMs were detected in 3 (27.3%) patients. Renal duplex Doppler was performed in 6 patients, and all of these patients were diagnosed with AVM, demonstrating a vascular turbulence or blood-rich area. Twelve patients were initially treated with transarterial embolization. Nephrectomy was performed in two patients due to persistent bleeding with hypovolemic shock. Conclusions: We should consider possible AVMs in patients who were not detected by conventional work up for hematuria, especially in mid-aged, pregnant, or recently delivered women. Renal duplex Doppler might be the optimal diagnostic modality in these patients. Our diagnostic algorithm could be aid to diagnosis and treatment for renal AVM patients.
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Affiliation(s)
- Seung-Kwon Choi
- Department of Urology, Seoul Medical Center, Seoul 02053, Korea;
| | - Gyeong Eun Min
- Department of Urology, School of Medicine, Kyung Hee University, Seoul 05278, Korea;
| | - Dong-Gi Lee
- Department of Urology, School of Medicine, Kyung Hee University, Seoul 05278, Korea;
- Correspondence: ; Tel.: +82-2-440-7735; Fax: +82-2-440-7744
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Chen CJ, Sheehan JP. Arteriovenous Malformation-A Real Can of Worms. Int J Radiat Oncol Biol Phys 2021; 111:854-855. [PMID: 34655560 DOI: 10.1016/j.ijrobp.2021.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Schimmel K, Ali MK, Tan SY, Teng J, Do HM, Steinberg GK, Stevenson DA, Spiekerkoetter E. Arteriovenous Malformations-Current Understanding of the Pathogenesis with Implications for Treatment. Int J Mol Sci 2021; 22:ijms22169037. [PMID: 34445743 PMCID: PMC8396465 DOI: 10.3390/ijms22169037] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/18/2022] Open
Abstract
Arteriovenous malformations are a vascular anomaly typically present at birth, characterized by an abnormal connection between an artery and a vein (bypassing the capillaries). These high flow lesions can vary in size and location. Therapeutic approaches are limited, and AVMs can cause significant morbidity and mortality. Here, we describe our current understanding of the pathogenesis of arteriovenous malformations based on preclinical and clinical findings. We discuss past and present accomplishments and challenges in the field and identify research gaps that need to be filled for the successful development of therapeutic strategies in the future.
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Affiliation(s)
- Katharina Schimmel
- Division Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA; (K.S.); (M.K.A.)
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA 94305, USA
| | - Md Khadem Ali
- Division Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA; (K.S.); (M.K.A.)
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA 94305, USA
| | - Serena Y. Tan
- Department of Pathology, Stanford University, Stanford, CA 94305, USA;
| | - Joyce Teng
- Department of Dermatology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA 94305, USA;
| | - Huy M. Do
- Department of Radiology (Neuroimaging and Neurointervention), Stanford University, Stanford, CA 94305, USA;
- Department of Neurosurgery and Stanford Stroke Center, Stanford University, Stanford, CA 94305, USA;
| | - Gary K. Steinberg
- Department of Neurosurgery and Stanford Stroke Center, Stanford University, Stanford, CA 94305, USA;
| | - David A. Stevenson
- Department of Pediatrics, Division of Medical Genetics, Stanford University, Stanford, CA 94305, USA;
| | - Edda Spiekerkoetter
- Division Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA 94305, USA; (K.S.); (M.K.A.)
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +1-(650)-739-5031
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Funaki B, Zangan S. Pulmonary Arteriovenous Malformation Embolization: So Much Left to Learn. J Vasc Interv Radiol 2021; 32:1009-1010. [PMID: 34210474 DOI: 10.1016/j.jvir.2021.03.543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Brian Funaki
- Department of Vascular and Interventional Radiology, University of Chicago Medicine, 5840 S. Maryland Ave., MC 2026, Chicago, IL 60546.
| | - Steven Zangan
- Department of Vascular and Interventional Radiology, University of Chicago Medicine, 5840 S. Maryland Ave., MC 2026, Chicago, IL 60546
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50
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Jubashi A, Yamaguchi D, Nagatsuma G, Inoue S, Tanaka Y, Yoshioka W, Hino N, Morisaki T, Ario K, Fukui K, Ishimaru H, Tsunada S. Successful retrograde transvenous embolization under balloon occlusion for rectal arteriovenous malformation. Clin J Gastroenterol 2021; 14:594-598. [PMID: 33420667 PMCID: PMC8016791 DOI: 10.1007/s12328-020-01335-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/25/2020] [Indexed: 11/29/2022]
Abstract
A 57-year-old man was admitted to our hospital because of frequent hematochezia. Colonoscopy exhibited a submucosal tumor-like lesion in the lower rectum. Abdominal contrast-enhanced computed tomography showed a rectal arteriovenous malformation (AVM) on the right side wall of the lower rectum. The feeder was the superior rectal artery, with early venous return. Embolization of the draining vein and feeding artery of the AVM with N-butyl-2-cyanoacrylate under balloon occlusion was planned. Angiography of the superior rectal artery showed the nidus in the rectum with early venous return of contrast material. The portal vein was punctured percutaneously under ultrasound guidance, and a balloon catheter advanced to the distal part of the superior rectal vein. Venography under balloon occlusion showed the outflow vein and nidus. Transvenous and transarterial nidus embolization with N-butyl-2-cyanoacrylate under balloon occlusion was then performed. Since the embolization, there have been no further episodes of bleeding. There is no established treatment for AVMs. Successful treatment requires targeting and eradication of the nidus. We successfully performed embolization therapy for a rectal AVM via a retrograde transvenous approach. This technique may be suitable for completely eradicating the nidus without the risk of embolism.
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Affiliation(s)
- Amane Jubashi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Daisuke Yamaguchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan.
- Division of Gastroenterology, Department of Internal Medicine, Saga University, Saga, 849-8501, Japan.
| | - Goshi Nagatsuma
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Suma Inoue
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Yuichiro Tanaka
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Wataru Yoshioka
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Naoyuki Hino
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Tomohito Morisaki
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Keisuke Ario
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Kenichiro Fukui
- Department of Radiology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | | | - Seiji Tsunada
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
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