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Embolo/sclerotherapy for the treatment of hand arteriovenous malformations: a single-center retrospective cohort experience

PURPOSE: To retrospectively report our preliminary experience of treating hand arteriovenous malformations (AVMs) with embolo/sclerotherapy. MATERIALS AND METHODS: Retrospectively review the demographics, treatment detail, outcome data, and complications of 13 consecutive patients with hand AVMs fro...

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Autores principales: Fan, Xueqiang, Zhang, Jianbin, Liu, Peng, Ye, Zhidong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10312000/
https://www.ncbi.nlm.nih.gov/pubmed/37396293
http://dx.doi.org/10.3389/fsurg.2023.1191876
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author Fan, Xueqiang
Zhang, Jianbin
Liu, Peng
Ye, Zhidong
author_facet Fan, Xueqiang
Zhang, Jianbin
Liu, Peng
Ye, Zhidong
author_sort Fan, Xueqiang
collection PubMed
description PURPOSE: To retrospectively report our preliminary experience of treating hand arteriovenous malformations (AVMs) with embolo/sclerotherapy. MATERIALS AND METHODS: Retrospectively review the demographics, treatment detail, outcome data, and complications of 13 consecutive patients with hand AVMs from January 2018 to December 2021. We embolize the dominant outflow vein with elastic coils and then use absolute ethanol or polidocanol for intravascular sclerotherapy and bleomycin for interstitial sclerotherapy. RESULTS: Yakes type II presents in four lesions, type IIIa in six, and type IIIb in three. A total of 29 treatment episodes were conducted for the 13 patients (1 episode for 3 patients, 2 for 4 patients, and 3 for 6 patients; the repeated treatment rate was 76.9%). The mean stretched length of coils for 1 treatment episode was 95 cm. The mean absolute ethanol dosage was 6.8 ml (range 4–30 ml). In addition, 10 ml of 3% polidocanol foam was injected and interstitial sclerotherapy with 150,000 IU bleomycin was performed on every patient. The post-operative arterial-dominant outflow vein pressure index (AVI) increased in the 29 procedures (6.55 ± 1.68 vs. 9.38 ± 2.80, P < 0.05). The Mann–Whitney U test showed that the post-operative AVI was higher in patients without re-intervention (P < 0.05). Local swelling occurred after all the procedures. Blistering occurred in 6 of the patients in 13 (44.8%) of the 29 procedures. Superficial skin necrosis occurred in 3 of the patients in 5 (17.2%) of the 29 procedures. The swelling, blistering, and superficial skin necrosis recovered within 4 weeks. No finger amputation occurred. The follow-up time was 6 months. The 6-month assessment of clinical improvement after the last treatment episode showed that 2 patients were cured, 10 were improved, and 1 remained unchanged. With regard to angiographic evaluation, 9 showed partial response and 4 complete response. CONCLUSION: Embolo/sclerotherapy can be effective and safe for hand AVM. The AVI increased significantly after embolo/sclerotherapy, and the index may be valuable in predicting recurrence in further study.
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spelling pubmed-103120002023-07-01 Embolo/sclerotherapy for the treatment of hand arteriovenous malformations: a single-center retrospective cohort experience Fan, Xueqiang Zhang, Jianbin Liu, Peng Ye, Zhidong Front Surg Surgery PURPOSE: To retrospectively report our preliminary experience of treating hand arteriovenous malformations (AVMs) with embolo/sclerotherapy. MATERIALS AND METHODS: Retrospectively review the demographics, treatment detail, outcome data, and complications of 13 consecutive patients with hand AVMs from January 2018 to December 2021. We embolize the dominant outflow vein with elastic coils and then use absolute ethanol or polidocanol for intravascular sclerotherapy and bleomycin for interstitial sclerotherapy. RESULTS: Yakes type II presents in four lesions, type IIIa in six, and type IIIb in three. A total of 29 treatment episodes were conducted for the 13 patients (1 episode for 3 patients, 2 for 4 patients, and 3 for 6 patients; the repeated treatment rate was 76.9%). The mean stretched length of coils for 1 treatment episode was 95 cm. The mean absolute ethanol dosage was 6.8 ml (range 4–30 ml). In addition, 10 ml of 3% polidocanol foam was injected and interstitial sclerotherapy with 150,000 IU bleomycin was performed on every patient. The post-operative arterial-dominant outflow vein pressure index (AVI) increased in the 29 procedures (6.55 ± 1.68 vs. 9.38 ± 2.80, P < 0.05). The Mann–Whitney U test showed that the post-operative AVI was higher in patients without re-intervention (P < 0.05). Local swelling occurred after all the procedures. Blistering occurred in 6 of the patients in 13 (44.8%) of the 29 procedures. Superficial skin necrosis occurred in 3 of the patients in 5 (17.2%) of the 29 procedures. The swelling, blistering, and superficial skin necrosis recovered within 4 weeks. No finger amputation occurred. The follow-up time was 6 months. The 6-month assessment of clinical improvement after the last treatment episode showed that 2 patients were cured, 10 were improved, and 1 remained unchanged. With regard to angiographic evaluation, 9 showed partial response and 4 complete response. CONCLUSION: Embolo/sclerotherapy can be effective and safe for hand AVM. The AVI increased significantly after embolo/sclerotherapy, and the index may be valuable in predicting recurrence in further study. Frontiers Media S.A. 2023-06-16 /pmc/articles/PMC10312000/ /pubmed/37396293 http://dx.doi.org/10.3389/fsurg.2023.1191876 Text en © 2023 Fan, Zhang, Liu and Ye. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Fan, Xueqiang
Zhang, Jianbin
Liu, Peng
Ye, Zhidong
Embolo/sclerotherapy for the treatment of hand arteriovenous malformations: a single-center retrospective cohort experience
title Embolo/sclerotherapy for the treatment of hand arteriovenous malformations: a single-center retrospective cohort experience
title_full Embolo/sclerotherapy for the treatment of hand arteriovenous malformations: a single-center retrospective cohort experience
title_fullStr Embolo/sclerotherapy for the treatment of hand arteriovenous malformations: a single-center retrospective cohort experience
title_full_unstemmed Embolo/sclerotherapy for the treatment of hand arteriovenous malformations: a single-center retrospective cohort experience
title_short Embolo/sclerotherapy for the treatment of hand arteriovenous malformations: a single-center retrospective cohort experience
title_sort embolo/sclerotherapy for the treatment of hand arteriovenous malformations: a single-center retrospective cohort experience
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10312000/
https://www.ncbi.nlm.nih.gov/pubmed/37396293
http://dx.doi.org/10.3389/fsurg.2023.1191876
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