Surgical Treatment for Congenital Arteriovenous Malformation: 10 Years' Experience

Division of Vascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
European Journal of Vascular and Endovascular Surgery (Impact Factor: 2.49). 08/2006; 32(1):101-6. DOI: 10.1016/j.ejvs.2006.01.004
Source: PubMed


We report our 10 years experience of the surgical treatment of congenital arteriovenous malformation (AVM).
We retrospectively reviewed the medical records of 145 patients with AVM who visited Samsung Medical Center in Korea from 1994 to 2003. Among the 145 patients, 21 patients were operated on. Preoperative embolo/sclerotherapy was done in 20 out of the 21 patients.
The surgically treated AVMs were 13 cases of head and neck lesions, four cases of upper extremity lesions, one case each of back lesion, uterus lesion, lower extremity lesion and multiple site lesions. There were 10 patients with the extratruncular infiltrating type, nine patients with the extratruncular limited type, one patient with a truncular superficial AV fistula and one patient with a mixed type. Fourteen cases were operated on for cosmetic reasons and since they had localized lesions, and five cases were operated on for tissue necrosis. Fourteen cases were cured by a single operation, yet seven cases needed several sessions of operation to cure the AVM or to promote wound healing after surgery.
The surgical treatment of AVM is a challenging issue for vascular surgeons. To minimise the complications related to surgery, a multidisciplinary team approach should be considered.

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    • "AVMs are known to arise from a cluster of aberrant arteriovenous shunts. They are comprised of numerous hypertrophic tortuous arteries that drain into arterialized veins forming a vascular nidus, which thought to have growth potential [3-5]. Although, AVMs are thought to grow synchronously with a child’s development, as a result of hormonal changes, inappropriate therapy and trauma, dramatic enlargement can occur [6-10]. "
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    ABSTRACT: Arteriovenous malformations (AVMs) are a type of high-flow vascular malformations that most commonly occurs in the head and neck. They are present at birth but are usually clinically asymptomatic until later in life. The pathogenesis of AVMs remains unclear and therapeutic approaches to AVMs are unsatisfied. In order to provide a tool for studying the pathogenesis and therapies of this disease, we established and studied a xenograft animal model of human AVMs. Fresh human AVMs specimens harvested from 4 patients were sectioned (5x5x5 mm) and xenografted subcutaneously in 5 immunologically naive nude mice (Athymic Nude-Foxn1nu). Each mouse had four pieces specimens in four quadrants along the back. The grafts were observed weekly for volume, color and texture. The grafts were harvested at every 30 days intervals for histologic examination. All grafts (n = 20) were sectioned and stained for hematoxylin and eosin (H&E). Comparative pathologic evaluation of the grafts and native AVMs were performed by two blinded pathologists. Immunohistochemical examination of human-specific nuclear antigen, vascular endothelial growth factor receptor-2 (VEGFR-2) and Ki-67 was performed. Clinical characteristics and pathologic diagnosis of native human derived AVMs were confirmed. 85% (n = 17) of AVM xenografts survived although the sizes decreased after implantation. Histological examination demonstrated numerous small and medium-size vessels and revealed structural characteristics matching the native AVMs tissue.76.5% (n = 13) of the surviving xenografts were positive for Ki-67 and human-specific nuclear antigen suggesting survival of the human derived tissue, 52.9% (n = 9) were positive for VEGFR-2. This preliminary xenograft animal model suggests that AVMs can survive in the nude mouse. The presence of human-specific nuclear antigen, VEGFR-2, and Ki-67 demonstrates the stability of native tissue qualities within the xenografts.
    Orphanet Journal of Rare Diseases 12/2013; 8(1):199. DOI:10.1186/1750-1172-8-199 · 3.36 Impact Factor
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    • "Despite the very preliminary nature of this type of procedure in this indication, cryoablation may also be effective for relieving symptoms, preventing the growth and/or local recurrence of venous vascular malformations (VM). In particular cryotherapy could be an alternative solution in the event of recurrence after sclerotherapy or in the case of vascular malformations with a mainly solid component [12]. "
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    ABSTRACT: Studies of percutaneous cryotherapy in the treatment of benign or malignant soft tissue tumours are rare and mainly involve small populations. Nevertheless, results show cryotherapy's potential in terms of local control of tumours, analgesic efficacy, reduced intra- and postoperative complications, and reduction in the length of convalescence after the procedure. The objective of this update is to set out the short-term prospects for this technique in the treatment of soft tissue tumours, so that it may be more widely offered in these indications.
    Diagnostic and interventional imaging 03/2013; 94(4). DOI:10.1016/j.diii.2013.02.001
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    • "In the present case, it was difficult to have the history of the patient. Often, the AVM remains as an asymptomatic lesion like a birthmark or a swelling and the symptoms may only arise if the adjacent structures are compressed [9]. "
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    ABSTRACT: An abnormal communication between an artery and a vein is known as arteriovenous malformation (AVM) or arteriovenous fistula (AVF). The AVM or the AVF might be congenital in origin or even acquired. The arteriovenous communications are usually surgically made in patients undergoing repeated hemodialysis, while suffering from any chronic renal disease. The abnormal arteriovenous communications may be asymptomatic in nature. The arteriovenous communications might be an incidental finding during any anatomical dissections or medico-legal autopsies. The present study reports the presence of BBC on both sides of a 54-year-old male cadaver who died of road traffic accident. There was a communication between the brachial artery and the brachial vein, 11.5 cm above the medial epicondyle. The oblique communicating channel measured 1.5 cm in length and connected the brachial artery to the brachial vein. A detailed histological study of the communication showed the presence of thick tunica media. Knowledge of arteriovenous communications may be beneficial for any academic studies and equally important for vascular surgeons and radiologists performing angiographic studies.
    Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 02/2008; 49(3):421-3. · 0.66 Impact Factor
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