Extracranial Arteriovenous Malformations: A Clinical and Radiological Review of our Cohort for an Improved Classification and Management

Details

Supervisors

Boon, Laurence

Faculty

Faculté de médecine et médecine dentaire

Degree label

Master [180] en médecine

Abstract

Introduction: Arteriovenous malformations are vascular anomalies that directly connect an artery to a vein, without the interlaying capillary bed. They are thought to be due to errors in embryonic vasculogenesis. Arteriovenous malformations are dynamic vascular anomalies that expand with age and following treatment. The ideal treatment for AVM’s along with patient prognosis is an area of ongoing clinical trials. The Aim of this study was to identify clinical and/or radiological features of AVM’s that are indicators of prognosis in patients. Methods: Patients with extracranial arteriovenous malformations treated at the Cliniques Universitaires Saint-Luc from 1970-2020 were reviewed. The location of the malformation, the symptoms & clinical examination, their radiological aspect, their genetics, and different treatments were taken into account to assess prognosis. Prognosis was mainly estimated by our decision to treat the malformation, since this implied it was more severe. Recurrence of AVM was defined as clinical symptoms associated with radiological confirmation. Results: This study included 107 patients. Every AVM characteristic (ie location, symptoms…) was compared to the decision to proceed with treatment or to abstain. A family history of vascular anomalies was correlated with a decreased treatment rate (p=0.004). AVM’s in the head and neck region, and more precisely in the face were correlated with an increased treatment rate (p=0.015). Conversely, AVM’s in the upper limbs were linked to a decreased treatment rate (p<0.001). Symptoms such as ulceration (p=0.035) and tinnitus (p<0.001) were associated with an increased treatment rate. MRI and arteriography did not show statistical significance concerning our decision to treat the patient. The SECg classification used to classify AVM’s demonstrated statistical significance, but the YAKES classification did not. In patients treated by embolization only, relapse was less frequent when the AVM’s were treated at a pauci-symptomatic stage (p=0.021), than when they were treated at a clinically invasive stage (p=0.021). Conclusion Anatomical distribution of AVM’s seem to guide our therapeutic choice. The SECg classification seems promising to determine treatment guidelines. The Yakes classification fails to do so however, but may be effective in orientating our endovascular approaches. Embolization for clinically lower-staged AVM’s results in less relapse than in more clinically expressive AVM’s.