Extremity arteriovenous malformations involving the bone: therapeutic outcomes of ethanol embolotherapy.
OBJECTIVE
To assess retrospectively the therapeutic results, complications, and therapeutic approach to ethanol embolotherapy of extremity arteriovenous malformations (AVMs) involving the bone.


METHODS
From December 1996 to May 2009, 22 patients (12 male, 10 female; eight children, 14 adults; age range, 1-64 years) with extremity AVMs involving the bone underwent staged ethanol embolotherapy (range, 1-12 procedures; mean, 4.4 procedures) under general anesthesia. Four patients had pure bone AVMs and 18 had mixed bone and soft-tissue AVMs. Pulmonary artery pressure and arterial blood pressure were monitored as ethanol was injected. Ethanol embolotherapy was performed by direct puncture and/or transcatheter approach. Therapeutic outcomes were established by evaluation of the clinical response of symptoms and signs, as well as the degree of devascularization at follow-up angiography or computed tomography.


RESULTS
Ninety-six ethanol embolotherapy procedures were performed in 22 patients. Four (18%) were cured, 14 (64%) showed improvement, three (14%) showed no change, and one (4%) experienced treatment failure and amputation of the affected extremity. Ethanol embolotherapy was considered effective (ie, combined cure and improvement outcomes) in 18 patients (82%). Ten patients (45%) experienced complications. Twelve minor complications (skin and transient peripheral nerve injury; 13%) and one major complications (longstanding nerve palsy; 1%) occurred in 96 procedures.


CONCLUSIONS
Ethanol embolotherapy of extremity AVMs involving the bone has the potential to eliminate or improve symptoms in a high percentage of patients, with an acceptable risk of minor and major complications.
Do
Young Soo
YS
Department of Radiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Kangnam-gu, Seoul 135-710, Korea. ysdo@skku.edu
Park
Kwang Bo
KB
Park
Hong Suk
HS
Cho
Sung Ki
SK
Shin
Sung Wook
SW
Moon
Jung Won
JW
Kim
Dong-Ik
DI
Kim
Young Wook
YW
Chang
Il Soo
IS
Lee
Sang Hyun
SH
Hwang
Hee Youn
HY
Hwang
Ji Hye
JH
Choo
In-Wook
IW
D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000628:therapy*; D001842:Bone and Bones / Q000002:abnormalities* / Q000098:blood supply* / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
D012597:Sclerosing Solutions