Tags

Type your tag names separated by a space and hit enter

Embolization Techniques for Arteriovenous Malformations in Parkes-Weber Syndrome.
Ann Vasc Surg. 2020 May 29 [Online ahead of print]AV

Abstract

BACKGROUND

Multiple high-flow arteriovenous malformations (AVMs) are the hallmark of Parkes-Weber syndrome (PWS). Surgical resection has historically shown poor outcomes with PWS. The aim of this study was to assess the management of PWS in the current era.

METHODS

A retrospective review was performed from 2004 to 2017 on all patients presenting to a single institution for the management of PWS. Presentation, techniques, complications, and outcomes were reviewed.

RESULTS

Fourteen patients (50% male) with PWS were seen at our institution, and mean age was 19.9 years (range, 4.7-68.8). The lower extremity was affected in 12 (86%) and the upper extremity in 2 (14%) patients. All patients presented with pain and swelling in the affected limb. Seven (50%) patients presented with ulcers, of which 3 (43%) had extensive wounds. Five (36%) patients had echocardiographic evidence of high-output cardiac failure. All patients underwent angiography with the intention to treat. Three (21%) patients were found to have diffuse arteriovenous communication with no discrete AVM nidus and thus did not undergo intervention. The remaining 11 (79%) patients underwent transcatheter embolization of the AVM's arterial inflow. Six (55%) patients required multiple or staged inflow embolization procedures, with a mean of 3.3 (range, 1-10) interventions. Thirty-two arterial embolization procedures were performed in total. n-Butyl-2-cyanoacrylate (nBCA) adhesive was used in 22 (69%), microspheres in 8 (25%), and a combination of coils and nBCA adhesive in 2 (6%) cases. Technical angiographic success was seen in all patients. Six (55%) patients also had interventions to treat the venous component of the malformation, either concomitantly or during a separate procedure. This included radiofrequency ablation in 1 (17%), coil embolization in 1 (17%), sodium tetradecyl sulfate (STS) sclerotherapy in 2 (33%), and a combination of STS, coil embolization, and vein stripping in 2 (33%) patients. Ten (91%) patients experienced a partial response and 1 (9%) patient experienced no response to treatment. No patients had a complete response, as expected with the diffuse nature of this disease. There were no periprocedural complications. Two of 3 patients with complex wounds required major amputations for gangrene, including one above-knee and one below-knee amputation at 128 months and 66 months after the index procedure, respectively.

CONCLUSIONS

AVMs in PWS can be successfully treated by a transcatheter approach. Multiple interventions are usually required. Patients with extensive wounds remain at risk for loss of limb.

Authors+Show Affiliations

Department of Surgery, Lenox Hill Hospital, Northwell Health System, New York, NY. Electronic address: allan.m.conway@doctors.org.uk.Department of Surgery, Lenox Hill Hospital, Northwell Health System, New York, NY.Department of Surgery, Lenox Hill Hospital, Northwell Health System, New York, NY.The AVM Center of New York at Lenox Hill, Northwell Health System, New York, NY.Department of Surgery, Lenox Hill Hospital, Northwell Health System, New York, NY.Department of Surgery, Lenox Hill Hospital, Northwell Health System, New York, NY.The AVM Center of New York at Lenox Hill, Northwell Health System, New York, NY.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32479884

Citation

Conway, Allan M., et al. "Embolization Techniques for Arteriovenous Malformations in Parkes-Weber Syndrome." Annals of Vascular Surgery, 2020.
Conway AM, Qato K, Nguyen Tran NT, et al. Embolization Techniques for Arteriovenous Malformations in Parkes-Weber Syndrome. Ann Vasc Surg. 2020.
Conway, A. M., Qato, K., Nguyen Tran, N. T., Short, H., Giangola, G., Carroccio, A., & Rosen, R. J. (2020). Embolization Techniques for Arteriovenous Malformations in Parkes-Weber Syndrome. Annals of Vascular Surgery. https://doi.org/10.1016/j.avsg.2020.05.039
Conway AM, et al. Embolization Techniques for Arteriovenous Malformations in Parkes-Weber Syndrome. Ann Vasc Surg. 2020 May 29; PubMed PMID: 32479884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Embolization Techniques for Arteriovenous Malformations in Parkes-Weber Syndrome. AU - Conway,Allan M, AU - Qato,Khalil, AU - Nguyen Tran,Nhan T, AU - Short,Heather, AU - Giangola,Gary, AU - Carroccio,Alfio, AU - Rosen,Robert J, Y1 - 2020/05/29/ PY - 2020/01/16/received PY - 2020/05/01/revised PY - 2020/05/02/accepted PY - 2020/6/2/pubmed PY - 2020/6/2/medline PY - 2020/6/2/entrez JF - Annals of vascular surgery JO - Ann Vasc Surg N2 - BACKGROUND: Multiple high-flow arteriovenous malformations (AVMs) are the hallmark of Parkes-Weber syndrome (PWS). Surgical resection has historically shown poor outcomes with PWS. The aim of this study was to assess the management of PWS in the current era. METHODS: A retrospective review was performed from 2004 to 2017 on all patients presenting to a single institution for the management of PWS. Presentation, techniques, complications, and outcomes were reviewed. RESULTS: Fourteen patients (50% male) with PWS were seen at our institution, and mean age was 19.9 years (range, 4.7-68.8). The lower extremity was affected in 12 (86%) and the upper extremity in 2 (14%) patients. All patients presented with pain and swelling in the affected limb. Seven (50%) patients presented with ulcers, of which 3 (43%) had extensive wounds. Five (36%) patients had echocardiographic evidence of high-output cardiac failure. All patients underwent angiography with the intention to treat. Three (21%) patients were found to have diffuse arteriovenous communication with no discrete AVM nidus and thus did not undergo intervention. The remaining 11 (79%) patients underwent transcatheter embolization of the AVM's arterial inflow. Six (55%) patients required multiple or staged inflow embolization procedures, with a mean of 3.3 (range, 1-10) interventions. Thirty-two arterial embolization procedures were performed in total. n-Butyl-2-cyanoacrylate (nBCA) adhesive was used in 22 (69%), microspheres in 8 (25%), and a combination of coils and nBCA adhesive in 2 (6%) cases. Technical angiographic success was seen in all patients. Six (55%) patients also had interventions to treat the venous component of the malformation, either concomitantly or during a separate procedure. This included radiofrequency ablation in 1 (17%), coil embolization in 1 (17%), sodium tetradecyl sulfate (STS) sclerotherapy in 2 (33%), and a combination of STS, coil embolization, and vein stripping in 2 (33%) patients. Ten (91%) patients experienced a partial response and 1 (9%) patient experienced no response to treatment. No patients had a complete response, as expected with the diffuse nature of this disease. There were no periprocedural complications. Two of 3 patients with complex wounds required major amputations for gangrene, including one above-knee and one below-knee amputation at 128 months and 66 months after the index procedure, respectively. CONCLUSIONS: AVMs in PWS can be successfully treated by a transcatheter approach. Multiple interventions are usually required. Patients with extensive wounds remain at risk for loss of limb. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/32479884/Embolization_Techniques_for_Arteriovenous_Malformations_in_Parkes-Weber_Syndrome L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(20)30446-5 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.