Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
Hacettepe University School of Medicine, Ankara, Turkey.
J Endovasc Ther. 2024 Oct;31(5):797-804. doi: 10.1177/15266028231166546. Epub 2023 Apr 21.
Patients with arteriovenous malformations (AVMs) have a lower health-related quality of life (QoL) than the general population. QoL assessment of patients with peripheral AVMs after endovascular treatment is scarce in the literature. Radiologic and clinical outcomes are not always correlated in vascular malformation treatment. This study aimed to investigate the relationship between clinical outcomes, QoL, and angiographic outcomes.
Patients with peripheral AVM that underwent endovascular treatment between January 2009 and December 2021 in a single center were retrospectively evaluated. Patients' characteristics (age, sex), AVM characteristics (Schobinger classification, location, angiographic architecture), previous treatment, treatment characteristics (type of endovascular approach, embolizing agent and number of sessions), percentages of angiographic response, complications, and recurrence were evaluated. The angiographic architecture was evaluated according to the Yakes classification. The questionnaire was applied for evaluation of clinical response and QoL. Patients older than 12 years and those who can be contacted were included in clinical and QoL analysis. Clinical response was defined as improvement in the patient's most important pretreatment symptom. Treatment response was defined as clinical response plus >50% angiographic response.
Eighty-six patients (41 males [47.7%], 45 females [52.3%]) were included in angiographic analysis. The mean age was 28.44±12.99 years (range=5-61). Forty-three patients (50%) had previous treatment. The median number of sessions was 2 (range 1-15, InterQuartile Range [IOR]=2). Sixty-one patients (30 males [49.2%], 31 females [50.8%]) were included in clinical analysis. The clinical response rate was 73.8%, 95% confidence interval (CI) [0.60, 0.84]. The treatment response rate was 45.9%, 95% CI [0.33, 0.59]. The complication rate was 8.2%. Before treatment, 48 patients (78.7%) reported a negative impact on their QoL. Thirty-three of 48 patients (68.8%) reported improvement on their QoL after treatment. Higher Schobinger stages were related to a negative impact on QoL before treatment (p<0.01). Yakes types were not related to QoL (p=0.065). Clinical response was related to improvement on QoL after treatment (p<0.01). Angiographic and treatment responses were not related to improved QoL after treatment (p=0.52 and p=0.055, respectively).
Angiographic architecture and outcomes were not always reflected in QoL after endovascular treatment.
This study's findings will help clinicians with what to focus on in AVM treatment and how to monitor patients with peripheral AVM after endovascular treatment. Rather than relying too much on the angiographic response, patients should be checked for symptoms and quality of life improvement. No clear data in the literature regarding the applicability of the Yakes Classification in patients with previous treatment. This study questioned the applicability of the Yakes Classification in patients with previous treatments. In this study, type 4 AVMs were more common in patients with previous treatment.
动静脉畸形（AVM）患者的健康相关生活质量（QoL）低于一般人群。关于接受血管内治疗后外周 AVM 患者的 QoL 评估在文献中很少见。血管畸形治疗中的放射学和临床结果并不总是相关的。本研究旨在探讨临床结果、QoL 和血管造影结果之间的关系。
回顾性评估了 2009 年 1 月至 2021 年 12 月在单一中心接受血管内治疗的外周 AVM 患者。评估患者特征（年龄、性别）、AVM 特征（Schobinger 分类、位置、血管造影结构）、既往治疗、治疗特征（血管内方法类型、栓塞剂和治疗次数）、血管造影反应百分比、并发症和复发情况。根据 Yakes 分类评估血管造影结构。问卷调查用于评估临床反应和 QoL。纳入年龄大于 12 岁且可联系的患者进行临床和 QoL 分析。临床反应定义为患者最重要的治疗前症状改善。治疗反应定义为临床反应加上 >50%的血管造影反应。
86 名患者（41 名男性[47.7%]，45 名女性[52.3%]）纳入血管造影分析。平均年龄为 28.44±12.99 岁（范围=5-61）。43 名患者（50%）有既往治疗。中位治疗次数为 2 次（范围 1-15，IQR=2）。61 名患者（30 名男性[49.2%]，31 名女性[50.8%]）纳入临床分析。临床反应率为 73.8%，95%置信区间（CI）[0.60，0.84]。治疗反应率为 45.9%，95%CI[0.33，0.59]。并发症发生率为 8.2%。治疗前，48 名患者（78.7%）报告 QoL 受到负面影响。48 名患者中的 33 名（68.8%）报告治疗后 QoL 有所改善。较高的 Schobinger 分期与治疗前 QoL 受到负面影响相关（p<0.01）。Yakes 类型与 QoL 无关（p=0.065）。临床反应与治疗后 QoL 改善相关（p<0.01）。血管造影和治疗反应与治疗后 QoL 改善无关（p=0.52 和 p=0.055）。
血管内治疗后血管造影结构和结果并不总是反映在 QoL 中。
本研究的发现将帮助临床医生关注 AVM 治疗的重点以及如何监测血管内治疗后外周 AVM 患者。临床医生不应过分依赖血管造影反应，而应检查患者的症状和生活质量改善情况。文献中没有关于 Yakes 分类在有既往治疗患者中适用性的明确数据。本研究对 Yakes 分类在有既往治疗的患者中的适用性提出了质疑。在本研究中，有既往治疗的患者中更常见 4 型 AVM。
