Cho Sung Ki, Do Young Soo, Kim Dong Ik, Kim Young Wook, Shin Sung Wook, Park Kwang Bo, Ko Justin Sang, Lee Ae Ryoung, Choo Sung Wook, Choo In Wook
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Radiol. 2008 May-Jun;9(3):258-67. doi: 10.3348/kjr.2008.9.3.258.
To assess retrospectively the treatment results of ethanol embolization of peripheral arteriovenous malformations (AVMs) with a dominant outflow vein (DOV).
Nineteen patients who had peripheral AVMs with a DOV were enrolled in this study (mean age, 29.7 years; range, 15-42 years). Fifty-one ethanol embolizations (mean, 2.7; range, 1-8) were performed by direct puncture (n = 29), the transarterial approach (n = 13), the transvenous approach (n = 5), or a combination of methods (n = 4) under general anesthesia. Coil and/or core-removed guide wire embolization of the DOV or another flow occlusion technique (i.e., use of an external pneumatic pressure cuff) to achieve vascular stasis were required in all patients during ethanol embolization. Clinical follow-up (mean, 22.2 months; range, 1-53 months) was performed for all patients, and imaging follow-up (mean, 22.1 months; range, 2-53 months) from the last treatment session was performed for 14 patients. The therapeutic outcome (cure, improvement, no change, or aggravation) was assessed according to the clinical response and the degree of devascularization at angiography.
Ethanol embolization was considered as an effective procedure in all patients. Thirteen (68%) of 19 patients were cured and six displayed improvement. Three of six patients with improvement needed further treatment sessions for residual AVMs. Four patients (21%) experienced a total of eight complications. Five complications (three events of a distal embolism and one event each of a urinary bladder necrosis and a brain infarct related to the accidental cannulation of the common carotid artery during insertion of the Swan-Ganz catheter) were major and three complications (skin necrosis) were minor.
Peripheral AVMs with a DOV can be effectively treated with a high cure rate by the use of ethanol embolization alone or in conjunction with the use of coil and/or core-removed guide wire embolization.
回顾性评估乙醇栓塞治疗伴有优势流出静脉（DOV）的外周动静脉畸形（AVM）的治疗效果。
19例患有伴有DOV的外周AVM患者纳入本研究（平均年龄29.7岁；范围15 - 42岁）。在全身麻醉下，通过直接穿刺（n = 29）、经动脉途径（n = 13）、经静脉途径（n = 5）或联合方法（n = 4）进行了51次乙醇栓塞（平均2.7次；范围1 - 8次）。所有患者在乙醇栓塞期间均需要对DOV进行弹簧圈和/或取出内芯的导丝栓塞或其他血流阻断技术（即使用外部气压袖带）以实现血管淤滞。对所有患者进行了临床随访（平均22.2个月；范围1 - 53个月），对14例患者进行了自最后一次治疗后起的影像学随访（平均22.1个月；范围2 - 53个月）。根据临床反应和血管造影时的去血管化程度评估治疗结果（治愈、改善、无变化或加重）。
乙醇栓塞在所有患者中均被认为是一种有效的治疗方法。19例患者中有13例（68%）治愈，6例有改善。6例有改善的患者中有3例因残留AVM需要进一步治疗。4例患者（21%）共发生8例并发症。5例并发症（3例远端栓塞事件以及1例膀胱坏死和1例与插入Swan - Ganz导管期间意外插管至颈总动脉相关的脑梗死事件）为严重并发症，3例并发症（皮肤坏死）为轻微并发症。
伴有DOV的外周AVM单独使用乙醇栓塞或联合使用弹簧圈和/或取出内芯的导丝栓塞可有效治疗，治愈率高。
