Endovascular approach as first-line therapy for congenital arteriovenous malformations – a case series

Detalhes bibliográficos
Autor(a) principal: Pinelo, Andreia
Data de Publicação: 2023
Outros Autores: Loureiro, Luís, Almeida, Paulo, Mendes, Daniel, Veterano, Carlos, Castro, João, Rocha, Henrique, Almeida, Rui
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://doi.org/10.48750/acv.488
Resumo: INTRODUCTION: Congenital vascular malformations are entities with a broad spectrum of presentations and variable prognosis. They typically present at a young age and are historically associated with extensive resection surgeries and with high morbidity. This study aims to evaluate the results of arteriovenous malformations (AVMs) embolization as a first-line approach in lesions which are not suitable for surgical resection. METHODS: A retrospective analysis of the clinical records of patients with infiltrative arteriovenous malformations who underwent embolization at our center between 2019 and 2021 was performed. The Schobinger Classification was applied to categorize the clinical stage. Angiographic findings were reported according to the Yakes classification. The decrease in the Schöbinger grade after treatment, the need for reintervention and the associated complications were the main outcomes. A descriptive statistical analysis was performed. RESULTS: Nine patients undergoing embolization of infiltrative arteriovenous malformations were evaluated, accounting for a total of seventeen interventions. There was a preponderance of females (n=6; 66.7%) and the mean age of referral to the Vascular Surgery consultation and the first treatment was 16.8 (±12.9) and 20.9 (± 14.5) years, respectively. All patients were in stage II (n=4; 44.4%) or III (n=5; 55.6%) of Schöbinger. The angiographic pattern of the AVMs was classified according to the Yakes Classification, which guided the approach. Yakes type IIa was found most frequently (n=6; 55.6%), followed by type IV (n=2; 22.2%) and type IIb (n=1; 1.1%). Patients underwent AVM embolization via transarterial, transvenous or direct nidus puncture with sclerosing agents, liquid embolizers, microparticles and microcoils, separately or in combination. The median number of interventions per patient was 1 (1 – 5) and Yakes type IV appears to be associated with a higher rate of reintervention. Reduction of the Schöbinger stage was achieved in 7 (77.8%) patients with clinical resolution in 3 (33.3%). Tissue necrosis was the only complication reported in this series (n=2; 11,8%). CONCLUSION: The endovascular approach of arteriovenous malformations through nidus and/or afferent/ efferent embolization requires a detailed angiographic characterization but seems to be an effective strategy with a low risk of complications. The Yakes classification, can be useful both in guiding the approach and inpredicting the need for reintervention.
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spelling Endovascular approach as first-line therapy for congenital arteriovenous malformations – a case seriesArteriovenous malformationvascular anomaliesembolizationendovascularYakes ClassificationINTRODUCTION: Congenital vascular malformations are entities with a broad spectrum of presentations and variable prognosis. They typically present at a young age and are historically associated with extensive resection surgeries and with high morbidity. This study aims to evaluate the results of arteriovenous malformations (AVMs) embolization as a first-line approach in lesions which are not suitable for surgical resection. METHODS: A retrospective analysis of the clinical records of patients with infiltrative arteriovenous malformations who underwent embolization at our center between 2019 and 2021 was performed. The Schobinger Classification was applied to categorize the clinical stage. Angiographic findings were reported according to the Yakes classification. The decrease in the Schöbinger grade after treatment, the need for reintervention and the associated complications were the main outcomes. A descriptive statistical analysis was performed. RESULTS: Nine patients undergoing embolization of infiltrative arteriovenous malformations were evaluated, accounting for a total of seventeen interventions. There was a preponderance of females (n=6; 66.7%) and the mean age of referral to the Vascular Surgery consultation and the first treatment was 16.8 (±12.9) and 20.9 (± 14.5) years, respectively. All patients were in stage II (n=4; 44.4%) or III (n=5; 55.6%) of Schöbinger. The angiographic pattern of the AVMs was classified according to the Yakes Classification, which guided the approach. Yakes type IIa was found most frequently (n=6; 55.6%), followed by type IV (n=2; 22.2%) and type IIb (n=1; 1.1%). Patients underwent AVM embolization via transarterial, transvenous or direct nidus puncture with sclerosing agents, liquid embolizers, microparticles and microcoils, separately or in combination. The median number of interventions per patient was 1 (1 – 5) and Yakes type IV appears to be associated with a higher rate of reintervention. Reduction of the Schöbinger stage was achieved in 7 (77.8%) patients with clinical resolution in 3 (33.3%). Tissue necrosis was the only complication reported in this series (n=2; 11,8%). CONCLUSION: The endovascular approach of arteriovenous malformations through nidus and/or afferent/ efferent embolization requires a detailed angiographic characterization but seems to be an effective strategy with a low risk of complications. The Yakes classification, can be useful both in guiding the approach and inpredicting the need for reintervention.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2023-01-07info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.488https://doi.org/10.48750/acv.488Angiologia e Cirurgia Vascular; Vol. 18 No. 3 (2022): September; 176-181Angiologia e Cirurgia Vascular; Vol. 18 N.º 3 (2022): September; 176-1812183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/488http://acvjournal.com/index.php/acv/article/view/488/303Copyright (c) 2022 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessPinelo, AndreiaLoureiro, LuísAlmeida, PauloMendes, DanielVeterano, CarlosCastro, JoãoRocha, HenriqueAlmeida, Rui2023-01-11T10:18:35Zoai:ojs.acvjournal.com:article/488Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:30:07.777520Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Endovascular approach as first-line therapy for congenital arteriovenous malformations – a case series
title Endovascular approach as first-line therapy for congenital arteriovenous malformations – a case series
spellingShingle Endovascular approach as first-line therapy for congenital arteriovenous malformations – a case series
Pinelo, Andreia
Arteriovenous malformation
vascular anomalies
embolization
endovascular
Yakes Classification
title_short Endovascular approach as first-line therapy for congenital arteriovenous malformations – a case series
title_full Endovascular approach as first-line therapy for congenital arteriovenous malformations – a case series
title_fullStr Endovascular approach as first-line therapy for congenital arteriovenous malformations – a case series
title_full_unstemmed Endovascular approach as first-line therapy for congenital arteriovenous malformations – a case series
title_sort Endovascular approach as first-line therapy for congenital arteriovenous malformations – a case series
author Pinelo, Andreia
author_facet Pinelo, Andreia
Loureiro, Luís
Almeida, Paulo
Mendes, Daniel
Veterano, Carlos
Castro, João
Rocha, Henrique
Almeida, Rui
author_role author
author2 Loureiro, Luís
Almeida, Paulo
Mendes, Daniel
Veterano, Carlos
Castro, João
Rocha, Henrique
Almeida, Rui
author2_role author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Pinelo, Andreia
Loureiro, Luís
Almeida, Paulo
Mendes, Daniel
Veterano, Carlos
Castro, João
Rocha, Henrique
Almeida, Rui
dc.subject.por.fl_str_mv Arteriovenous malformation
vascular anomalies
embolization
endovascular
Yakes Classification
topic Arteriovenous malformation
vascular anomalies
embolization
endovascular
Yakes Classification
description INTRODUCTION: Congenital vascular malformations are entities with a broad spectrum of presentations and variable prognosis. They typically present at a young age and are historically associated with extensive resection surgeries and with high morbidity. This study aims to evaluate the results of arteriovenous malformations (AVMs) embolization as a first-line approach in lesions which are not suitable for surgical resection. METHODS: A retrospective analysis of the clinical records of patients with infiltrative arteriovenous malformations who underwent embolization at our center between 2019 and 2021 was performed. The Schobinger Classification was applied to categorize the clinical stage. Angiographic findings were reported according to the Yakes classification. The decrease in the Schöbinger grade after treatment, the need for reintervention and the associated complications were the main outcomes. A descriptive statistical analysis was performed. RESULTS: Nine patients undergoing embolization of infiltrative arteriovenous malformations were evaluated, accounting for a total of seventeen interventions. There was a preponderance of females (n=6; 66.7%) and the mean age of referral to the Vascular Surgery consultation and the first treatment was 16.8 (±12.9) and 20.9 (± 14.5) years, respectively. All patients were in stage II (n=4; 44.4%) or III (n=5; 55.6%) of Schöbinger. The angiographic pattern of the AVMs was classified according to the Yakes Classification, which guided the approach. Yakes type IIa was found most frequently (n=6; 55.6%), followed by type IV (n=2; 22.2%) and type IIb (n=1; 1.1%). Patients underwent AVM embolization via transarterial, transvenous or direct nidus puncture with sclerosing agents, liquid embolizers, microparticles and microcoils, separately or in combination. The median number of interventions per patient was 1 (1 – 5) and Yakes type IV appears to be associated with a higher rate of reintervention. Reduction of the Schöbinger stage was achieved in 7 (77.8%) patients with clinical resolution in 3 (33.3%). Tissue necrosis was the only complication reported in this series (n=2; 11,8%). CONCLUSION: The endovascular approach of arteriovenous malformations through nidus and/or afferent/ efferent embolization requires a detailed angiographic characterization but seems to be an effective strategy with a low risk of complications. The Yakes classification, can be useful both in guiding the approach and inpredicting the need for reintervention.
publishDate 2023
dc.date.none.fl_str_mv 2023-01-07
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.uri.fl_str_mv https://doi.org/10.48750/acv.488
https://doi.org/10.48750/acv.488
url https://doi.org/10.48750/acv.488
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv http://acvjournal.com/index.php/acv/article/view/488
http://acvjournal.com/index.php/acv/article/view/488/303
dc.rights.driver.fl_str_mv Copyright (c) 2022 Angiologia e Cirurgia Vascular
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2022 Angiologia e Cirurgia Vascular
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
dc.source.none.fl_str_mv Angiologia e Cirurgia Vascular; Vol. 18 No. 3 (2022): September; 176-181
Angiologia e Cirurgia Vascular; Vol. 18 N.º 3 (2022): September; 176-181
2183-0096
1646-706X
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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