Peripheral Arteriovenous Malformations and their Response to Treatment Modalities: Experience at Tertiary Care Hospitals

Abstract

Background: Arteriovenous malformations result in abnormal communication between veins and arteries. Treatment of AVMs can be surgical or non-surgical. This study aimed to assess the response of Peripheral Arteriovenous Malformations (AVMs) to various treatment modalities. Methodology: This cross-sectional study was performed at Combined Military Hospital Lahore, Rawalpindi, and Midcity Hospital, Lahore Pakistan, from January 2016 to June 2020. Patients were divided into two groups based on gender. Their demographic data, clinical presentation, and treatments provided were assessed and comparison was done using Chi-Square Test. Results: Of the 43 patients, 74.4% (n=32) were females with a male-to-female ratio of 1:3. Mean age was 27± 6 years (males) and 17± 4 years (females). Low-flow AVMs were more prevalent in females (81%, n=27).  In males, 50% (n=5) AVMs were on the trunk whereas in females 93.9% (n=31) AVMs were on limbs.  Doppler-guided foam sclerotherapy (DGFS) as the sole treatment was used in 95.3% (n=41) patients while 32.5% (n=14) patients underwent DGFS followed by surgical excision. In 4.6% (n=2) cases, angioembolization followed by surgical excision was done. One patient was treated with sirolimus. Recurrence was found in 20.9% (n=9) cases, of which 66.6% (n=6) had high-flow AVMs. Conclusion: Male patients presented late and with mostly high-flow head and neck AVMs. Sclerotherapy alone or surgical excision with preoperative sclerotherapy or embolotherapy is an efficacious curative treatment for AVMs while sirolimus can be offered as a palliative option. Key words: Arteriovenous Malformations, Enbucrilate, Sclerotherapy, Vascular Malformations