Vascular Surgery Department, Hospital Torrecárdenas, Almería, Spain.
Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.
Auris Nasus Larynx. 2020 Apr;47(2):181-190. doi: 10.1016/j.anl.2019.11.008. Epub 2019 Dec 18.
The purpose of this study was to review the outcomes of the different therapies for extracranial head and neck arteriovenous malformations (AVMs). AVMs are high-flow congenital vascular anomalies. They are composed of a complex system of vessels directly connecting feeding arteries to draining veins forming a nidus. They may be potentially life-threatening due to progressive symptoms and infiltrative disease. Extracranial AVMs most commonly affect the head and neck area (47.4%) followed by the extremities (28.5%). AVMs are best characterized as being either focal or diffuse. Focal AVMs have good outcomes following adequate treatment. Diffuse lesions have multiple feeding vessel, which results in high rates of recurrence despite treatment. The management of AVMs includes conventional surgery and endovascular techniques. A combination of embolization and surgical resection has become the treatment of choice over the last years. The main goal of both forms of treatment being the complete blockage or resection of the nidus. Transcatheter embolization of vessels has evolved over the years and new embolic agents have emerged. The types of materials available for embolization are classified into mechanical devices, liquid agents and particulates. Efficacy, rate of recurrence and most common complications were evaluated. AVMs recurrence after embolization or resection is reported in up to 80% of cases. Incomplete resection and embolization can induce aggressive growth of the remaining nidus and the risk of progression is up to 50% within the first 5 years and recurrences can occur up to 10 years later. Although ethanol seems to be associated with the highest degree of cure and permanent occlusion, the overall complication rate reported was 48%. Other materials, such as cyanoacrylate, have obtained modest rates of complete remission, while the reported rates of complete regression of AVMs with Fibrin glue and Polyvinyl alcohol are above 50%. At present, there are no unified agreement on the ideal embolic agent. Therefore, a multidisciplinary approach is recommended to support decision making about the best therapeutic approach and to achieve optimal outcome. A long-term post-treatment follow-up is recommended to recognize early recurrence.
本研究旨在回顾不同疗法治疗颅外头颈部动静脉畸形（AVM）的结果。AVM 是一种高流量先天性血管畸形。它们由一个复杂的血管系统组成，直接将供血动脉连接到引流静脉，形成一个病灶。由于进行性症状和浸润性疾病，它们可能具有潜在的致命性。颅外 AVM 最常影响头颈部（47.4%），其次是四肢（28.5%）。AVM 最好的特征是局灶性或弥漫性。局灶性 AVM 在得到充分治疗后有良好的结果。弥漫性病变有多个供血血管，因此尽管进行了治疗，但复发率仍然很高。AVM 的治疗包括传统手术和血管内技术。近年来，栓塞和手术切除的联合已成为首选治疗方法。两种治疗方法的主要目标都是完全阻塞或切除病灶。血管内栓塞技术多年来不断发展，新的栓塞剂也相继出现。用于栓塞的材料类型分为机械装置、液体剂和颗粒剂。评估了疗效、复发率和最常见的并发症。栓塞或切除后 AVM 的复发率高达 80%。不完全切除和栓塞可导致剩余病灶的侵袭性生长，前 5 年内进展的风险高达 50%，10 年后可能会复发。虽然乙醇似乎与最高程度的治愈率和永久性闭塞相关，但报告的总体并发症发生率为 48%。其他材料，如氰基丙烯酸酯，获得了适度的完全缓解率，而纤维蛋白胶和聚乙烯醇治疗 AVM 的完全消退率报告则高于 50%。目前，对于理想的栓塞剂尚无统一的共识。因此，建议采用多学科方法来支持最佳治疗方法的决策，并取得最佳疗效。建议进行长期的治疗后随访，以早期发现复发。
