Department of Cardiovascular Medicine, Vilnius University, Lithuania.
Medicina (Kaunas). 2012;48(8):388-98.
Arteriovenous malformations (AVMs) are an uncommon vascular pathology that remains challenging to accurately diagnose and successfully treat. This study introduces a novel way to evaluate AVM treatment outcomes using transarterial lung perfusion scintigraphy (TLPS) and reports our treatment results.
The patients treated for extracranial AVMs were studied retrospectively. Diagnosis and outcomes were based on clinical data, ultrasonography, magnetic resonance imaging, computed tomography, angiography, and TLPS studies. The influence of gender; location, form, and stage of AVMs; first attempt at treatment; and treatment modalities was analyzed. Outcomes were defined as positive (cure, improvement, and remission) or negative (no remission and aggravation).
Of the 324 patients with congenital vascular malformations, 129 (39.8%) presented with AVMs, and the data of 56 treated patients with AVMs were analyzed. Of the 29 patients in the endovascularly treated group, 15 in the surgically treated group, and 12 in the combined treatment group, 24 (82.8%), 14 (93.3%), and 10 patients (83.3%), respectively, had positive outcomes (P>0.05). All outcomes were positive in surgically treated patients with extratruncular limited AVMs, and these patients were more likely to be cured as compared with those who had other forms of AVMs (OR, 5.8; 95% CI, 1.1-29; P=0.02). The patients with more advanced AVMs (stages III and IV) and with AVMs in the gluteal and pelvic region were more likely to have the worst outcomes than those with stage II AVMs (OR, 8.2; 95% CI, 1-72; P=0.03) and with AVMS in other locations (OR, 5.8; 95% CI, 1.1-29; P=0.02), respectively. Gender and age did not significantly influence treatment results (P>0.05). The TLPS data of 17 patients showed AV shunting ranging from 0% to 92%, which combined with other results helped identify 9 patients who needed further interventions, 6 who were treated successfully, and 2 who had insignificant shunting.
The best outcomes were achieved in surgically treated patients with localized lesions and less advanced AVMs. For the first time in Lithuania, a modified TLPS method has been introduced that enhances a hemodynamic assessment of AV shunting and provides with a more accurate evaluation of AVMs to better serve in planning future treatments.
动静脉畸形（AVM）是一种罕见的血管病理学，其准确诊断和成功治疗仍然具有挑战性。本研究引入了一种使用经动脉肺灌注闪烁显像（TLPS）评估 AVM 治疗结果的新方法，并报告了我们的治疗结果。
回顾性研究接受治疗的颅外 AVM 患者。诊断和结果基于临床数据、超声、磁共振成像、计算机断层扫描、血管造影和 TLPS 研究。分析了性别、AVM 的位置、形式和阶段、首次治疗尝试和治疗方式的影响。结果定义为阳性（治愈、改善和缓解）或阴性（无缓解和加重）。
在 324 例先天性血管畸形患者中，有 129 例（39.8%）表现为 AVM，对 56 例 AVM 治疗患者的数据进行了分析。在血管内治疗组的 29 例患者、手术治疗组的 15 例患者和联合治疗组的 12 例患者中，分别有 24 例（82.8%）、14 例（93.3%）和 10 例（83.3%）患者的结果为阳性（P>0.05）。手术治疗的患者中，所有结果均为阳性，且接受手术治疗的患者中，局限性 AVM 患者的治愈可能性明显高于其他形式的 AVM 患者（比值比，5.8；95%置信区间，1.1-29；P=0.02）。具有更高级别（III 期和 IV 期）AVM 和臀部和骨盆区域 AVM 的患者与具有 II 期 AVM 的患者相比（比值比，8.2；95%置信区间，1-72；P=0.03）和其他部位 AVM（比值比，5.8；95%置信区间，1.1-29；P=0.02）相比，更有可能出现最差的结果。性别和年龄对治疗结果没有显著影响（P>0.05）。17 名患者的 TLPS 数据显示 AV 分流率为 0%至 92%，结合其他结果，发现 9 名患者需要进一步干预，6 名患者治疗成功，2 名患者分流无明显变化。
在手术治疗的局限性病变和低级别 AVM 患者中取得了最佳结果。在立陶宛，首次引入了一种改良的 TLPS 方法，增强了对 AV 分流的血流动力学评估，并提供了对 AVM 的更准确评估，从而更好地为未来的治疗计划服务。
