Department of Radiology, University Hospital, LMU Munich, München, Germany.
Clinic of Radiology, University Hospital Muenster, Muenster, Germany.
Diagn Interv Radiol. 2022 Sep;28(5):486-494. doi: 10.5152/dir.2022.21644.
PURPOSE This study aimed to evaluate the safety and outcome of image-guided embolization for treating arteriovenous malformations (AVMs) of the hand using ethylene-vinyl alcohol copolymer (EVOH). METHODS A retrospective, multicenter cohort of 15 patients with AVMs of the hand treated with 35 imageguided embolotherapies using EVOH was investigated. Clinical history, symptomatology, and imaging findings were assessed to evaluate clinical outcome (symptom-free, partial relief of pain, no improvement of pain, and clinical progression despite embolization), lesion devascularization (total, 100%; near-total, 90%-99%; substantial, 70%-90%; partial, 30%-70%; and failure, 0%-30%), and peri- and postprocedural complication rates (major complications classified according to CIRSE guidelines). Substratification analysis was performed with respect to the involvement of different anatomical compartments and the injected volume of the embolic agent. RESULTS Patients were treated for pain (93.3%), skin ulceration (46.7%), and local bleeding (33.3%). The mean number of embolotherapies was 2.3 (±1.1) in 3 patients, a planned surgical resection was conducted after embolization. Clinical outcome after a median follow-up of 18 months revealed an overall response of 11/15 patients (73.3%). Imaging at last follow-up revealed 70%- 99% reduced vascularization in 12/15 patients (80%) including 2 patients (13.3%) with a neartotal devascularization of 90%-99%. Peri- and postprocedural complications occurred in 8.5% and 31.5%, respectively, including 17.1% major complications, in 1 case requiring a previously unplanned resection. Involvement of the finger was associated with increased rates of persistent symptoms compared to the other groups (P=.049). No significant difference between the embolic agent volume injected and complication rates was found (P=.372). CONCLUSION Image-guided embolization using EVOH-based liquid embolic agents is effective for treating AVMs of the hand in the mid-term.
目的 本研究旨在评估使用乙烯-乙烯醇共聚物（EVOH）对手部动静脉畸形（AVM）进行影像引导栓塞治疗的安全性和疗效。
方法 回顾性分析了 15 例手部 AVM 患者的临床资料，这些患者共接受了 35 次 EVOH 引导的栓塞治疗。评估了临床病史、症状和影像学表现，以评估临床疗效（无症状、疼痛部分缓解、疼痛无改善和尽管栓塞仍有临床进展）、病变血管化程度（完全、100%；近完全、90%-99%；明显、70%-90%；部分、30%-70%；失败、0%-30%）和围手术期并发症发生率（根据 CIRSE 指南分类的主要并发症）。对不同解剖部位受累和栓塞剂注射量进行了分层分析。
结果 患者因疼痛（93.3%）、皮肤溃疡（46.7%）和局部出血（33.3%）接受治疗。3 例患者平均接受 2.3（±1.1）次栓塞治疗，1 例患者在栓塞后计划行手术切除。中位随访 18 个月后的临床结果显示，15 例患者中有 11 例（73.3%）得到了总体缓解。最后一次随访的影像学检查显示，12/15 例患者（80%）的血管化程度降低了 70%-99%，其中 2 例患者（13.3%）的血管化程度降低了近完全（90%-99%）。分别有 8.5%和 31.5%的患者发生了围手术期和术后并发症，包括 17.1%的主要并发症，1 例患者需要进行先前未计划的切除。与其他组相比，手指受累与持续症状的发生率增加相关（P=.049）。未发现注射的栓塞剂体积与并发症发生率之间存在显著差异（P=.372）。
结论 使用基于 EVOH 的液体栓塞剂进行影像引导栓塞治疗手部 AVM 是一种有效的中期治疗方法。
