title: Diagnostic methods, treatment modalities, and follow-up of extracranial arteriovenous malformations.
abstract: OBJECTIVE
  Arteriovenous malformations (AVMs) are an uncommon vascular pathology that remains challenging to accurately diagnose and successfully treat. This study introduces a novel way to evaluate AVM treatment outcomes using transarterial lung perfusion scintigraphy (TLPS) and reports our treatment results.
  
  
  METHODS
  The patients treated for extracranial AVMs were studied retrospectively. Diagnosis and outcomes were based on clinical data, ultrasonography, magnetic resonance imaging, computed tomography, angiography, and TLPS studies. The influence of gender; location, form, and stage of AVMs; first attempt at treatment; and treatment modalities was analyzed. Outcomes were defined as positive (cure, improvement, and remission) or negative (no remission and aggravation).
  
  
  RESULTS
  Of the 324 patients with congenital vascular malformations, 129 (39.8%) presented with AVMs, and the data of 56 treated patients with AVMs were analyzed. Of the 29 patients in the endovascularly treated group, 15 in the surgically treated group, and 12 in the combined treatment group, 24 (82.8%), 14 (93.3%), and 10 patients (83.3%), respectively, had positive outcomes (P>0.05). All outcomes were positive in surgically treated patients with extratruncular limited AVMs, and these patients were more likely to be cured as compared with those who had other forms of AVMs (OR, 5.8; 95% CI, 1.1-29; P=0.02). The patients with more advanced AVMs (stages III and IV) and with AVMs in the gluteal and pelvic region were more likely to have the worst outcomes than those with stage II AVMs (OR, 8.2; 95% CI, 1-72; P=0.03) and with AVMS in other locations (OR, 5.8; 95% CI, 1.1-29; P=0.02), respectively. Gender and age did not significantly influence treatment results (P>0.05). The TLPS data of 17 patients showed AV shunting ranging from 0% to 92%, which combined with other results helped identify 9 patients who needed further interventions, 6 who were treated successfully, and 2 who had insignificant shunting.
  
  
  CONCLUSIONS
  The best outcomes were achieved in surgically treated patients with localized lesions and less advanced AVMs. For the first time in Lithuania, a modified TLPS method has been introduced that enhances a hemodynamic assessment of AV shunting and provides with a more accurate evaluation of AVMs to better serve in planning future treatments.
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Lithuania. birute.vaisnyte@santa.lt
authors.forename: Birutė
authors.initials: B
authors.lastname: Vaišnytė
authors.forename: Donatas
authors.initials: D
authors.lastname: Vajauskas
authors.forename: Darius
authors.initials: D
authors.lastname: Palionis
authors.forename: Nerijus
authors.initials: N
authors.lastname: Misonis
authors.forename: Marius
authors.initials: M
authors.lastname: Kurminas
authors.forename: Daiva
authors.initials: D
authors.lastname: Nevidomskytė
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Matačiūnas
authors.forename: Marijus
authors.initials: M
authors.lastname: Gutauskas
authors.forename: Aleksandras
authors.initials: A
authors.lastname: Laucevičius
mesh_terms: D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000628:therapy*; D002081:Buttocks / Q000002:abnormalities / Q000098:blood supply; D002648:Child; D002675:Child, Preschool; D005260:Female; D006257:Head / Q000002:abnormalities / Q000098:blood supply; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000002:abnormalities / Q000098:blood supply; D010388:Pelvis / Q000002:abnormalities / Q000098:blood supply; D034941:Upper Extremity / Q000098:blood supply; D038062:Upper Extremity Deformities, Congenital / Q000175:diagnosis; D055815:Young Adult