In a recent study published in the Journal of Vascular and Interventional Radiology, a team of researchers from Shanghai’s Ninth People’s Hospital demonstrated a promising technique for the treatment of high-flow arteriovenous malformations (AVMs) in the hands. The study, conducted between March 2013 and October 2016, assessed the management, outcomes, safety, and effectiveness of embolotherapy using absolute ethanol combined with coil-assisted dominant outflow vein (DOV) occlusion for these challenging lesions.
Arteriovenous malformations are abnormal, tangled blood vessels connecting arteries and veins, which can disrupt normal blood flow and oxygen circulation. When located in the hands, AVMs can cause pain, bleeding, and functional impairment, presenting a complex treatment challenge. Ethanol embolization is a minimally invasive procedure where ethanol is injected into the AVM to close off the abnormal blood vessels, but it carries risks due to the high-flow nature of these malformations.
The team, led by Dr. Li Xiao and Dr. Fan Xindong, evaluated a total of 12 consecutive patients who underwent ethanol embolization procedures, with a mean of 1.9 procedures per patient. They utilized both detachable and pushable coils in conjunction with ethanol to occlude the DOV, a technique aimed at reducing blood flow within the AVM and therefore minimizing the risk of non-target embolization and ethanol leakage.
Results and Outcomes
During the study period, patients treated with this method showed promising results. Out of the 12 patients, 7 (58.3%) showed a complete response to the treatment, while 5 (41.7%) exhibited partial responses. Follow-up ranging from 14 to 57 months (with a mean of 36.7 months) demonstrated sustained effectiveness of the procedure, with imaging follow-up results available for 8 patients between 8 and 25 months (with a mean of 16.6 months) post the final treatment session.
Safety Profile
The treatment was generally well-tolerated with all patients experiencing minor complications such as blistering and focal swelling, which resolved spontaneously without long-term sequelae. Importantly, no major complications were reported, validating this combination therapy of ethanol embolization and coil-assisted DOV occlusion as a safe option for high-flow AVM management in the hands.
DOI and References
The DOI of the study is 10.1016/j.jvir.2019.02.015, indicating its unique digital identifier in the scholarly database. Below are key references to the study’s methodology and findings:
1. Li, X., Su, L., Yang, X., Han, Y., Wang, D., Zheng, L., Wang, Z., & Fan, X. (2019). Embolotherapy for High-Flow Arteriovenous Malformations in the Hands Using Absolute Ethanol with Coil-Assisted Dominant Outflow Vein Occlusion. Journal of Vascular and Interventional Radiology, 30(6), 813-821. https://doi.org/10.1016/j.jvir.2019.02.015
2. Cho, S. K., Do, Y. S., Shin, S. W., Kim, D. I., Kim, Y. W., Park, K. B., … & Hyun, D. (2006). Ethanol embolization of arteriovenous malformations: Interim results. Radiology, 239(1), 263-270.
3. Yakes, W. F., Rossi, P., Odink, H. (1996). How I Do It. Arteriovenous Malformation Management. Cardiovascular and Interventional Radiology, 19(2), 65-71.
4. Do, Y. S., Yakes, W. F., Shin, S. W., Lee, B. B., Kim, D. I., Liu, W. C., … & Choo, I. W. (2005). Ethanol embolization of the arterial feeders for treatment of a large high-flow arteriovenous malformation. Journal of Vascular and Interventional Radiology, 16(6), 759-765.
5. Pollak, J. S., White Jr, R. I. (2001). The use of cyanoacrylate adhesives in peripheral embolization.
It is worth noting that further research and larger patient cohorts may provide more detailed insights into treatment protocols, outcome predictability, and longer-term effects.
Keywords
1. High-flow AVM treatment hand
2. Ethanol embolotherapy AVM
3. Coil-assisted DOV occlusion
4. Minimally invasive AVM management
5. Vascular interventional radiology AVM