Introduction This study aimed to assess the trend of percutaneous and open surgical procedures for peripheral arteriovenous malformations (AVMs) performed in NHS hospitals in England between 2012 and 2018. Methods Hospital Episode Statistics (HES) is a freely available data warehouse that represents the whole population of England served by the NHS. Data from the HES database was obtained and analysed for all hospital episodes between 2012 and 2018 for the total number and trend of ‘primary diagnosis’, and ‘primary procedures and interventions’ identified for peripheral AVMs. Results Over the period studied, there was an increase in the total number of admissions for peripheral AVMs; total primary diagnosis increased from 2242 to 2857 per year. Open surgery remained more commonly performed than percutaneous procedures throughout the studied period. However, the overall percentage of primary procedures and interventions being percutaneous in this period increased from 29.8% to 41.0% per year. The increase in the number of percutaneous procedures per year seemed to occur in both children (from 43 to 124) and adults (from 408 to 492) over the course of the study period. Conclusions This study concluded that open surgery remained the most commonly performed primary procedure for peripheral AVMs, although there was an increasing trend for percutaneous procedures in NHS hospitals in England. The increase in the number and percentage of percutaneous procedures for peripheral AVMs was likely to have significant resource implications for the provision of care for patients with peripheral AVMs in NHS hospitals.
Introduction To evaluate the efficacy and safety of embolo-sclerotherapy (EST) of low-flow vascular malformations (LFVM) in a specialist vascular anomalies centre. Methods All patients with LFVM who underwent EST from 01 January 2015–31 December 2019 were retrospectively reviewed. All ESTs were performed with foam STS 3%, ethanol, coils and/or other substances e.g. triamcinolone. LFVMs were grouped according to Puig's classification. The outcome measures were treatment effects and complications. Continuous variables were compared using ANOVA test. Other discrete variables were compared using Chi-squared tests. Differences were considered significant at P<0.05. Results A total of 207 patients, with a mean age of 32 years (range 1–71 years) were included. The use of EST with foam STS was significantly lower for type I LFVM (61.8%) compared to others (p<0.001). However, significantly higher type I LFVM (26.5%) were treated with surgery than EST (p<0.001). Overall, outcome categories were significantly different across all types of LFVM (p<0.001), with more discharges for Type I (52.9%) LFVMs but more failure to follow-up in patients with Type II (24.5%) LFVM. EST complications was significantly higher with type I (14.7%) LFVMs (p=0.030). The doses of STS in the first procedure were significantly different across all types of LFVM (p<0.001) with most type I LFVM patients receiving ≤2 ml. Conclusion EST particularly with foam sclerotherapy is clinically effective and safe for patients with LFVM especially in those with Puig's Type I and II lesions. This classification may provide an important guide to volume of sclerosant required and the potential success rate. Take-home message EST particularly with foam sclerotherapy is clinically effective and safe for patients with LFVM especially in those with Puig's Type I and II lesions. This classification may provide an important guide to volume of sclerosant required and the potential success rate.
Introduction To evaluate the efficacy and safety of EST, particularly foamed STS 3% in the treatment of arteriovenous malformations (AVMs) in a single specialist centre. Methods All patients with AVMs who underwent EST from 01 January 2015–31 December 2019 were retrospectively reviewed. Types of AVM were grouped into Schobinger's classification. All ESTs were performed either with foam sclerosants (STS 3% and polidocanol), ethanol, coils and/or other substances including Onyx and Gelfoam. Outcome measures included treatment effects and complications. Continuous variables were compared using ANOVA F test. Other discrete variables were compared using Chi-squared tests. Differences were considered significant at p<0.05. Results A total of 65 patients with AVMs, with a mean age of 36 years (range 1–74 years) were included. The age of patients with Type IV AVM were significantly (p=0.014) higher than others. The use of EST with foam STS was significantly lower for type IV AVM (0.0%) (p=0.003). Complications were significantly higher in type III AVM (21.1%)) (p=0.009). A total of 6 (9.2%) patients experienced complications for example, upper lip necrosis and partial facial weakness. The number of days in follow-up was not significantly different across all types of AVM. However, type II AVM showed a significantly lower number of days in follow-up (p=0.038). Conclusion EST, in particular foam sclerotherapy with STS 3%, was clinically effective and safe to treat patients with AVM. This study showed that foam sclerotherapy with STS 3% may be used as an alternative to ethanol in the treatment of AVMs. Take-home message EST, in particular foam sclerotherapy with STS 3%, was clinically effective and safe to treat patients with AVM. This study showed that foam sclerotherapy with STS 3% may be used as an alternative to ethanol in the treatment of AVMs.
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