Arteriovenous malformations of the body and extremities: analysis of therapeutic outcomes and approaches according to a modified angiographic classification.
OBJECTIVE
To propose a modified angiographic classification for peripheral arteriovenous malformations (AVMs) and to determine its value for assessing therapeutic outcomes and approaches to ethanol embolization of AVMs in the body and extremities.


METHODS
AVMs of the trunk and extremities were categorized according to the angiographic morphology of the nidus: type I (arteriovenous fistulae), type II (arteriolovenous fistulae), type IIIa (arteriolovenulous fistulae with non-dilated fistula), and type IIIb (arteriolovenulous fistulae with dilated fistula). Sixty-six patients (41 women; mean age 28.3 years, range 5-53) with inoperable AVMs in the body and extremities who underwent staged ethanol embolizations were retrospectively analyzed. Therapeutic outcomes and approaches were evaluated according the above classification system.


RESULTS
The 66 AVMs were composed of 30 (45%) type IIIb, 13 (20%) type II, 12 (18%) mixed types IIIa and IIIb, 9 (14%) mixed types II and IIIb, and 2 (3%) type IIIa. Ethanol embolization was most effective for type II (100%), and more effective for type IIIb (83%) than for type IIIa or mixed types (< or = 50%). Despite the use of the transarterial approach, direct puncture and transvenous approaches were more relevant for treating type II AVMs. Only the transarterial approach was used for treating type IIIa; both direct puncture and transarterial approaches were used for treating the other types.


CONCLUSIONS
The described angiographic classification provides considerable information concerning the characteristics of AVMs in the body and extremities, the optimal therapeutic approach, and the likely therapeutic outcome.
Cho
Sung Ki
SK
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Do
Young Soo
YS
Shin
Sung Wook
SW
Kim
Dong-Ik
DI
Kim
Young Wook
YW
Park
Kwang Bo
KB
Kim
Eun Jin
EJ
Ahn
Hyun Joo
HJ
Choo
Sung Wook
SW
Choo
In-Wook
IW
D000293:Adolescent; D000792:Angiography / Q000145:classification*; D001165:Arteriovenous Malformations / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D006225:Hand / Q000098:blood supply; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012997:Solvents / Q000627:therapeutic use; D016896:Treatment Outcome
D012997:Solvents; D000431:Ethanol