Multi–modal treatment of arterio–venous malformations and its outcome: a single centre prospective study

Dr Rakesh Kumar; Dr Abhishek Ranjan; Dr Rani Singh

Volume : VIII, Issue : IV, April - 2019

Multi–modal treatment of arterio–venous malformations and its outcome: a single centre prospective study

Dr Rakesh Kumar, Dr Abhishek Ranjan, Dr Rani Singh

Abstract :

50 patients from 6 months to 40 years of age presented to us from July 2017 to December 2018 were included in this study. The location of AVM and its symptoms was different. 20 yrs old was with recurrent strider and syncope for 8 years having worst symptoms. Preoperative colour Doppler and CT angiography was diagnostic of arterio–venous malformation (AVM). 25 patients were treated with sclera–therapy alone and 25 patients were treated with sclera–therapy and surgery or surgery alone. Both the groups have excellent outcome, so it is necessary to select the patient and plan the modality of treatment for each patient depending upon his profile of AVM. Complete excision of AVM with proximal and distal control of feeding vessels as well as draining vessels was necessary. Arterio–venous malformation (AVM) is a congenital vascular malformation that is neither a venous malformation nor a haemangioma. An AVM is a potentially life–threatening and limb–threatening lesion, especially the �fistulous� truncular form due to its unique emyological and hemodynamic characteristics. AVM treatment requires an early aggressive approach, one that is careful and based on a thorough assessment of the risks and benefits associated with the treatment plan. A successful treatment strategy requires an accurate assessment of the AVM taking into account the extent, severity and progression of the lesion. This is critical in order to minimize the morbidity associated with the currently available therapies. A multidisciplinary approach that integrates endovascular and surgical therapy can substantially improve the treatment results seen in patients with AVMs. Preliminary treatment of a fistulous AVM with coil embolization is essential in order to minimize associated morbidity and to alter the lesion hemodynamics from a high–flow lesion to a low–flow lesion that is more amenable to subsequent, definitive management with ethanol or NBCA glue embolo/sclerotherapy.