Peripheral Arteriovenous Malformations and Their Response to Treatment Modalities: A Single Surgeon’s Experience at Tertiary Care Hospitals

Abstract

Background Peripheral arteriovenous malformations (AVMs) are congenital defects resulting in abnormal connections between veins and arteries. We investigated a group of patients with peripheral AVMs to determine whether there were any gender differences in disease presentation and the response of AVMs to various modalities of treatment. Methodology The patients in this cross-sectional study were divided into two groups based on gender and their demographic data, clinical presentation at the time of diagnosis and response to treatment was assessed. Both surgical and nonsurgical treatment options were used. Nonsurgical options employed in the study included immunotherapy, embolotherapy and ultrasound-guided foam sclerotherapy (UGFS) Results Out of 43 patients, 74.4% were females with a male to female ratio of 1:3. The mean age at presentation in males was 27 years and 17 years in females. 60% of the male patients presented with high-flow AVMs while 81% of the female patients presented with low-flow lesions instead. Half of the AVMs in males were on the trunk whereas, in females, 93.9% were on the extremities. UGFS alone was used in 95.3% of patients while 32.5% of patients underwent UGFS followed by surgical excision. One patient was treated with sirolimus. In 4.6% of cases, embolization followed by surgical excision was performed. Recurrence was recorded in 20.9% of cases. Conclusions The clinical presentation of AVMs is notably different among the two genders. Sclerotherapy and embolotherapy proved to be effective treatment options. Larger studies, however, are needed to substantiate these claims. Keywords arteriovenous malformations, vascular malformations, sclerotherapy, embolotherapy, sirolimus

Incidence of Peripheral Vascular Malformations of Limbs in SMS Hospital Jaipur

“…The proliferating phase of infantile hemangiomas in its proliferation phase is also a high-flow lesion which is categorized as a vascular tumor rather than malformation which shows regression with time, unlike vascular malformations (Malik et al 2021) [17]. Similar results was also published by Usman, Rashid, et al [14] and Nosher J [18]. The "Little AVMs", as defined by Stein et al [19] are malformations on the spectrum between AVMs and venous malformations.…”

“…The male to female incidence of AVMs in our study was 1: 1.3 which is in concordance with the study of Lee BB et al who also reported male: female ratio of 1: 1 to 1: 2 [9], whereas Usman, Rashid, et al reported a slightly higher male to female ratio of 1:3. Furthermore, the average age at presentation in female patients was younger compared to male patients [14]. Two factors might account for these findings.…”