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Erschienen in: Annals of Vascular Surgery 4/2003

01.08.2003 | Original Article

Transcatheter Embolization of Extremity Vascular Malformations: The Long-term Success of Multiple Interventions

verfasst von: Caron B. Rockman, MD, Robert J. Rosen, MD, Glenn R. Jacobowitz, MD, Jonathan Weiswasser, MD, Dirk J. Hofstee, MD, B. Fioole, MD, Patrick J. Lamparello, MD, Mark A. Adelman, MD, Paul J. Gagne, MD, Thomas S. Riles , MD

Erschienen in: Annals of Vascular Surgery | Ausgabe 4/2003

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Abstract

Vascular malformations of the extremities present a difficult therapeutic challenge. Ligation of feeding vessels may lead to tissue necrosis and limb loss and can make subsequent attempts at transcatheter therapy impossible. The purpose of this study was to review our results with transcatheter embolization therapy in symptomatic vascular malformations in the upper and lower extremities in 50 patients. A retrospective review was conducted of a computerized database of all patients undergoing transcatheter therapy of peripheral vascular malformations at our institution. The mean age of the patients was 22 years (range 1-51 years), and 34% were male. The most common presenting symptoms included pain (80%), swelling (68%), ulceration or distal ischemia (18%), and hemorrhage (6%). Previous unsuccessful surgical treatment or embolization had been performed in 24% and 18% of patients, respectively. Predominantly venous lesions were treated by sclerotherapy with injection of ethanol. Arteriovenous and arterial lesions were treated by embolization via the arterial branch feeding vessels with cyanoacrylate. The most common vessels involved and treated were branches of the profunda femoris and tibial arteries (83% of lower extremity lesions), and branches of the brachial and radial arteries (82% of upper extremity lesions). Patients required a mean of 1.6 embolization procedures (range 1-5) over a mean period of 57 months. Sixteen patients (32%) underwent more than one embolization procedure. Of these, one was a planned staged procedure and 15 were performed secondary to residual or recurrent symptoms. Adjunctive surgical procedures were performed subsequent to embolization in three cases (6%). Ninety-two percent of patients remained asymptomatic or improved at a mean follow-up of 56 months. There was one case of limb loss (2%). Diffuse extremity vascular malformations are difficult to eradicate completely and recurrences are common. Although patients may require multiple embolization procedures and occasional adjunctive surgical resection, directed transcatheter embolization should be the treatment of choice for symptomatic extremity vascular malformations.
Literatur
1.
Zurück zum Zitat Szilagyi, DE, Smith, RF, Elliott, JP, Hageman, JH 1976Congenital arteriovenous anomalies of the limbs.Arch Surg111423429PubMed Szilagyi, DE, Smith, RF, Elliott, JP, Hageman, JH 1976Congenital arteriovenous anomalies of the limbs.Arch Surg111423429PubMed
2.
Zurück zum Zitat Coursely, G, Ivins, JC, Barker, NW 1956Congenital arteriovenous fistulas in the extremities: an analysis of 69 cases.Angiology7201217PubMed Coursely, G, Ivins, JC, Barker, NW 1956Congenital arteriovenous fistulas in the extremities: an analysis of 69 cases.Angiology7201217PubMed
3.
Zurück zum Zitat Gomes, MM, Bernatz, PE 1970Arteriovenous fistulas: a review and ten-year experience at the Mayo Clinic.Mayo Clinic Proc4582102 Gomes, MM, Bernatz, PE 1970Arteriovenous fistulas: a review and ten-year experience at the Mayo Clinic.Mayo Clinic Proc4582102
4.
Zurück zum Zitat Jacobowitz, GR, Rosen, RJ, Rockman, CB, et al. 2001Transcatheter embolization of complex pelvic malformations: results and long-term follow-up.J Vasc Surg335155CrossRefPubMed Jacobowitz, GR, Rosen, RJ, Rockman, CB,  et al. 2001Transcatheter embolization of complex pelvic malformations: results and long-term follow-up.J Vasc Surg335155CrossRefPubMed
5.
Zurück zum Zitat Szilagyi, DE, Elliott, JP, DeRusso, FJ, Smith, RF 1965Peripheral congenital arteriovenous fistulas.Surgery576181 Szilagyi, DE, Elliott, JP, DeRusso, FJ, Smith, RF 1965Peripheral congenital arteriovenous fistulas.Surgery576181
6.
Zurück zum Zitat Widlus, DM, Murray, RR, White Jr, RI, et al. 1988Congenital arteriovenous malformations: tailored embolotherapy.Radiology169511516PubMed Widlus, DM, Murray, RR, White Jr, RI,  et al. 1988Congenital arteriovenous malformations: tailored embolotherapy.Radiology169511516PubMed
7.
Zurück zum Zitat Flye, MW, Jordan, BP, Schwartz, MZ 1983Management of congenital arteriovenous malformations.Surgery94740747PubMed Flye, MW, Jordan, BP, Schwartz, MZ 1983Management of congenital arteriovenous malformations.Surgery94740747PubMed
8.
Zurück zum Zitat Natali, J, Merland, JJ 1976Superselective arteriography and therapeutic embolization for vascular malformations (angiodysplasias).J Cardiovasc Surg465472 Natali, J, Merland, JJ 1976Superselective arteriography and therapeutic embolization for vascular malformations (angiodysplasias).J Cardiovasc Surg465472
9.
Zurück zum Zitat Olcott, CIV, Newton, TH, Stoney, RJ, Ehrenfeld, WK 1976Intra-arterial embolization in the management of arteriovenous malformations.Surgery9312 Olcott, CIV, Newton, TH, Stoney, RJ, Ehrenfeld, WK 1976Intra-arterial embolization in the management of arteriovenous malformations.Surgery9312
10.
Zurück zum Zitat Rosen, RJ, Riles, TS 2000Congenital vascular malformations.Rutherford, RB eds. Vascular Surgery, 5th ed.W.B. SaundersPhiladelphia14511465 Rosen, RJ, Riles, TS 2000Congenital vascular malformations.Rutherford, RB eds. Vascular Surgery, 5th ed.W.B. SaundersPhiladelphia14511465
11.
Zurück zum Zitat Pearce, W, Rutherford, RB, Whitehill, TA, Davis, K 1988Nuclear magnetic resonance imaging in patient with congenital vascular malformations of the limbs.J Vasc Surg86470CrossRefPubMed Pearce, W, Rutherford, RB, Whitehill, TA, Davis, K 1988Nuclear magnetic resonance imaging in patient with congenital vascular malformations of the limbs.J Vasc Surg86470CrossRefPubMed
12.
Zurück zum Zitat Gomes, AS, Busuttil, RW, Baker, JD, Oppenheim, W, Machleder, HI, Moore, WS 1983Congenital arteriovenous malformations. The role of transcatheter arterial embolization.Arch Surg18817825 Gomes, AS, Busuttil, RW, Baker, JD, Oppenheim, W, Machleder, HI, Moore, WS 1983Congenital arteriovenous malformations. The role of transcatheter arterial embolization.Arch Surg18817825
13.
Zurück zum Zitat Kaufman, SL, Kumar, AA 1980Transcatheter embolization in the management of congenital arteriovenous malformations.Radiology1372129PubMed Kaufman, SL, Kumar, AA 1980Transcatheter embolization in the management of congenital arteriovenous malformations.Radiology1372129PubMed
14.
Zurück zum Zitat Rosen, RJ 1985Embolization in the treatment of arteriovenous malformations.Goldberg, HIHiggins, CBRing, EJ eds. Contemporary Imaging.University of California PressSan Francisco153 Rosen, RJ 1985Embolization in the treatment of arteriovenous malformations.Goldberg, HIHiggins, CBRing, EJ eds. Contemporary Imaging.University of California PressSan Francisco153
15.
Zurück zum Zitat Kromhout, JG, Horst, C, Peeters, F, Gerhard, M 1990The combined treatment of congenital vascular defects.Int Angiol9203207PubMed Kromhout, JG, Horst, C, Peeters, F, Gerhard, M 1990The combined treatment of congenital vascular defects.Int Angiol9203207PubMed
16.
Zurück zum Zitat Dickey, KW, Pollak, JS, et al. 1995Management of large high-flow arteriovenous malformations of the shoulder and upper extremity with transcatheter embolotherapy.J Vasc Int Radiol6765773 Dickey, KW, Pollak, JS,  et al. 1995Management of large high-flow arteriovenous malformations of the shoulder and upper extremity with transcatheter embolotherapy.J Vasc Int Radiol6765773
17.
Zurück zum Zitat Mendel, T, Louis, DS 1997Major vascular malformations of the upper extremity: long-term observation.J Hand Surg22A302306 Mendel, T, Louis, DS 1997Major vascular malformations of the upper extremity: long-term observation.J Hand Surg22A302306
18.
Zurück zum Zitat Carr, MM, Mahoney, JL, Bowen, CV 1994Extremity arteriovenous malformations: review of a series.Can J Surg37394399 Carr, MM, Mahoney, JL, Bowen, CV 1994Extremity arteriovenous malformations: review of a series.Can J Surg37394399
19.
Zurück zum Zitat White Jr, RI, Pollak, J, Persin, J, Henderson, KJ, Thomson, JG, Burdge, CM 2000Long-term outcome of embolotherapy and surgery for high-flow arteriovenous malformations.J Vasc Int Radiol1112851295 White Jr, RI, Pollak, J, Persin, J, Henderson, KJ, Thomson, JG, Burdge, CM 2000Long-term outcome of embolotherapy and surgery for high-flow arteriovenous malformations.J Vasc Int Radiol1112851295
Metadaten
Titel
Transcatheter Embolization of Extremity Vascular Malformations: The Long-term Success of Multiple Interventions
verfasst von
Caron B. Rockman, MD
Robert J. Rosen, MD
Glenn R. Jacobowitz, MD
Jonathan Weiswasser, MD
Dirk J. Hofstee, MD
B. Fioole, MD
Patrick J. Lamparello, MD
Mark A. Adelman, MD
Paul J. Gagne, MD
Thomas S. Riles , MD
Publikationsdatum
01.08.2003
Erschienen in
Annals of Vascular Surgery / Ausgabe 4/2003
Print ISSN: 0890-5096
Elektronische ISSN: 1615-5947
DOI
https://doi.org/10.1007/s10016-003-0029-7

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