Kitagawa Akira, Yamamoto Takahiro, Matsunaga Nozomu, Yamaji Mayako, Ikeda Shuji, Izumi Yuichiro, Hagihara Makiyo, Ota Toyohiro, Ishiguchi Tsuneo
Department of Radiology, Aichi Medical University, 1-1 YazakoKarimata, Nagakute City, Aichi, 480-1195, Japan.
Cardiovasc Intervent Radiol. 2018 Jun;41(6):856-866. doi: 10.1007/s00270-017-1855-2. Epub 2018 Feb 7.
To assess the safety and effectiveness of polidocanol sclerotherapy combined with transarterial embolization using a liquid adhesive agent (n-butyl cyanoacrylate, NBCA) for treatment of extracranial arteriovenous malformations (AVMs).
Twenty-three patients with symptomatic AVMs in the head and neck (6), upper (7) and lower extremity (10) with a mean age of 42 years (range 4-74) treated with polidocanol sclerotherapy were retrospectively assessed. AVMs were classified according to the angiographic morphology of the nidus. There were 2 type I, 6 type II, 6 type IIIa and 9 type IIIb. Arterial embolization using NBCA was performed to reduce arterial flow before sclerotherapy. Polidocanol mixed with contrast material or carbon dioxide was delivered by percutaneous direct puncture.
Treatment was successfully performed in all patients. In the mean follow-up period of 38 months, symptoms resolved or improved in 20/23 patients (87.0%). AVMs were devascularized 100% in 2 patients, 76-99% in 13, 50-75% in 7 and < 50% in 1. More than 50% devascularization was seen in 22 patients (95.6%). Two (8%) patients had complete remission, 17 (74%) had partial remission and 3 (13%) had no remission. There was no aggravation. Treatment was considered effective (complete and partial remission) in 20 patients (87.0%). Minor complications including localized arterial thrombosis (2) and spontaneously healing skin ulcer (1) were seen in 2 patients (8.7%). There were no major procedure-related complications.
Polidocanol sclerotherapy combined with transarterial embolization using NBCA is safe and effective for treating extracranial AVMs with an acceptable risk of minor complications.
评估聚多卡醇硬化疗法联合使用液体黏合剂（氰基丙烯酸正丁酯，NBCA）经动脉栓塞治疗颅外动静脉畸形（AVM）的安全性和有效性。
回顾性评估23例接受聚多卡醇硬化疗法治疗的有症状的头颈部（6例）、上肢（7例）和下肢（10例）AVM患者，平均年龄42岁（范围4 - 74岁）。根据畸形血管团的血管造影形态对AVM进行分类。有2例I型、6例II型、6例IIIa型和9例IIIb型。在硬化治疗前使用NBCA进行动脉栓塞以减少动脉血流。通过经皮直接穿刺注入与造影剂或二氧化碳混合的聚多卡醇。
所有患者均成功完成治疗。在平均38个月的随访期内，20/23例患者（87.0%）症状缓解或改善。2例患者的AVM血管完全消失，13例为76 - 99%，7例为50 - 75%，1例小于50%。22例患者（95.6%）血管消失超过50%。2例（8%）患者完全缓解，17例（74%）部分缓解，3例（13%）无缓解。无病情加重情况。20例患者（87.0%）治疗被认为有效（完全和部分缓解）。2例患者（8.7%）出现轻微并发症，包括局部动脉血栓形成（2例）和自发愈合的皮肤溃疡（1例）。无重大手术相关并发症。
聚多卡醇硬化疗法联合使用NBCA经动脉栓塞治疗颅外AVM是安全有效的，且有可接受的轻微并发症风险。
