School of Vascular Surgery, University of Milan, Milan, Italy -
Unit of Interventional Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
Int Angiol. 2021 Apr;40(2):165-169. doi: 10.23736/S0392-9590.21.04598-3. Epub 2021 Jan 26.
To assess imaging findings, describe endovascular technical aspects and analyzed procedural outcomes in a population of patients underwent limb arteriovenous malformation (LAVMs).
From January 2015 to December 2018, all consecutive patients underwent an endovascular procedure for ICD-9-CM codex for arteriovenous malformation problems were retrospective reviewed. Among these, patients with LAVMs were selected. Demographic, preoperative imaging, interventional and postprocedural data were collected for each patient and procedure. The International Society of Vascular Anomalies, the Cho-Do angiographic classification and the Schobinger clinical stage were used to describe disease type, aspect and clinical severity. Angiographic and clinical outcomes were also described.
During the study period, 76 intervention for AVMs were performed in 52 patients. Among these, 26 LAVMs were selected and analyzed in 21 patients (number of LAVMs per patient: 1.2±0.5), 14 affecting upper limbs, 17 lower limbs. Pain, discomfort and swelling were main symptoms reported (95%, 90% and 62%, respectively). Ultrasound scan, computed angiography tomography and magnetic resonance angiography were used - alone or in combination - as preoperative imaging in 67%, 62% and 48% of patients, respectively. Cho-Do class ≥3 was described in 70% of treated LAVMs and a Schobinger stage ≥2 in more than 90%. Ipsilateral femoral access with a 5F introducer was preferred. Selective embolization with glue was the most preferred technique (57%), in combination or not with microsphere embolization (19%) and/or direct nidus sclerotherapy (14%). Optimal and suboptimal results were achieved in 86% of cases. Further interventions were performed in 52% of cases, with more than two interventions in 29% of cases.
Quality of life, clinical picture and anatomical structure are items of paramount importance during preoperative LAVMs endovascular treatment planning. Treatment must be focused on LAVMs type, minimizing invasiveness and number of interventions, although secondary intervention rate remains quite high.
评估影像表现，描述腔内技术方面，并分析接受肢体动静脉畸形（LAVM）治疗的患者人群的治疗结果。
2015 年 1 月至 2018 年 12 月，回顾性分析了所有接受 ICD-9-CM 编码动静脉畸形问题血管内治疗的连续患者。在这些患者中，选择了 LAVM 患者。收集每位患者和手术的人口统计学、术前影像、介入和术后数据。国际脉管异常学会、Cho-Do 血管造影分类和 Schobinger 临床分期用于描述疾病类型、方面和临床严重程度。还描述了血管造影和临床结果。
在研究期间，52 名患者进行了 76 次 AVM 介入治疗。其中，26 例 LAVM 在 21 名患者中被选择和分析（每位患者的 LAVM 数量：1.2±0.5），14 例影响上肢，17 例影响下肢。主要报告的症状为疼痛、不适和肿胀（分别为 95%、90%和 62%）。67%、62%和 48%的患者分别单独或联合使用超声扫描、计算机血管造影 CT 和磁共振血管造影作为术前影像。70%的治疗 LAVM 描述为 Cho-Do 分级≥3，超过 90%的患者为 Schobinger 分期≥2。首选同侧股动脉入路和 5F 引入器。最常用的技术是胶栓塞（57%），联合或不联合微球栓塞（19%）和/或直接病灶硬化治疗（14%）。86%的病例达到了最佳和次优的结果。52%的病例进行了进一步的干预，29%的病例进行了两次以上的干预。
LAVM 血管内治疗计划的术前，生活质量、临床情况和解剖结构是至关重要的项目。治疗必须侧重于 LAVM 类型，尽量减少侵袭性和干预次数，尽管二次干预率仍然相当高。
