How Are We Doing At Treating Arteriovenous Malformations?
Daniel Demsey, Yuda Shih, Douglas J. Courtemanche, MD, Jugpal Arneja, MD.
University of British Columbia, Vancouver, BC, Canada.
Background: Arteriovenous malformations (AVMs) are incompletely understood complex vascular lesions that can cause significant deformity and morbidity. This study reviews our experience with AVMs at a quaternary care teaching hospital.
Methods: All patients treated for AVMs in our vascular anomaly clinic from 1991 to 2018 were reviewed. Data extraction included demographics, clinical presentation and course, radiology reports, and treatments. Progression was defined as advancement to a higher Schobinger stage (1 through 4) before treatment. Recurrence was defined as expansion following embolization or resection.
Results: 58 patients met inclusion criteria. 60.3% lesions were located in the head and neck, 10.3% on the trunk, and 29.3% on the extremities. 60% patients were female, and average follow up time was 2.9 years. 18.9% patients presented at Stage 1, 54.7% at Stage 2, 24.5% at Stage 3, and 1.9% at Stage 4. 98% of lesions progressed to a higher Schobinger stage without intervention. 124 interventions, including surgery and embolization, were performed on our cohort. Patients treated with embolization alone had a per treatment recurrence rate of 59%, and patients treated with surgical resection had a per treatment recurrence rate of 33%. Advanced lesions had higher rates of recurrence (Stage 2 60%, Stage 3 83%, Stage 4 100%). More advanced lesions also recurred more quickly. 3 lesions treated at Stage 1 did not show evidence of recurrence.
Conclusions: AVMs ultimately progress without intervention. We are not doing well at treating later stage AVMs as these lesions require a tremendous amount of resources and have a high rate of recurrence despite treatment. Our data suggests surgery had lower recurrences versus embolization alone. Treatment of lower-staged lesions may provide longer recurrence-free disease control.
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