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Transcatheter embolization of extremity vascular malformations: the long-term success of multiple interventions.
Ann Vasc Surg. 2003 Jul; 17(4):417-23.AV

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.

Authors+Show Affiliations

Department of Vascular Surgery, New York University Medical Center, New York, NY 10016, USA. caron.rockman@msnyuhealth.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14670021

Citation

Rockman, Caron B., et al. "Transcatheter Embolization of Extremity Vascular Malformations: the Long-term Success of Multiple Interventions." Annals of Vascular Surgery, vol. 17, no. 4, 2003, pp. 417-23.
Rockman CB, Rosen RJ, Jacobowitz GR, et al. Transcatheter embolization of extremity vascular malformations: the long-term success of multiple interventions. Ann Vasc Surg. 2003;17(4):417-23.
Rockman, C. B., Rosen, R. J., Jacobowitz, G. R., Weiswasser, J., Hofstee, D. J., Fioole, B., Lamparello, P. J., Adelman, M. A., Gagne, P. J., & Riles, T. S. (2003). Transcatheter embolization of extremity vascular malformations: the long-term success of multiple interventions. Annals of Vascular Surgery, 17(4), 417-23.
Rockman CB, et al. Transcatheter Embolization of Extremity Vascular Malformations: the Long-term Success of Multiple Interventions. Ann Vasc Surg. 2003;17(4):417-23. PubMed PMID: 14670021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transcatheter embolization of extremity vascular malformations: the long-term success of multiple interventions. AU - Rockman,Caron B, AU - Rosen,Robert J, AU - Jacobowitz,Glenn R, AU - Weiswasser,Jonathan, AU - Hofstee,Dirk J, AU - Fioole,B, AU - Lamparello,Patrick J, AU - Adelman,Mark A, AU - Gagne,Paul J, AU - Riles,Thomas S, PY - 2003/12/13/pubmed PY - 2004/1/30/medline PY - 2003/12/13/entrez SP - 417 EP - 23 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 17 IS - 4 N2 - 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. SN - 0890-5096 UR - https://www.unboundmedicine.com/medline/citation/14670021/Transcatheter_embolization_of_extremity_vascular_malformations:_the_long_term_success_of_multiple_interventions_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(06)61047-9 DB - PRIME DP - Unbound Medicine ER -