Ethanol embolotherapy of hand arteriovenous malformations

Abstract

Purpose: Ethanol embolotherapy is one of the established methods in the treatment of extremity arteriovenous malformations (AVMs). The purpose of this study was to report the application of this method to hand AVMs and to assess retrospectively the therapeutic outcomes and complications.

Patients and methods: From December 1998 to March 2009, we treated 31 patients with hand AVMs (16 women, 15 men, age range, 5-51 years; mean age, 27 years). With the patients under general anesthesia, they underwent staged ethanol embolotherapy (range, 1-11 sessions; mean, 2.8 sessions) by direct puncture and or intra-arterial approach. Therapeutic outcomes were evaluated by clinical responses of symptoms and signs, as well as the degree of devascularization on angiography. We also divided the patients into three groups according to the extent of involvement: a group involving fingers (n = 14), a group involving fingers and parts of the palm (n = 9), and a group involving parts of the palm (n = 8) and compared the therapeutic outcomes and complications among groups.

Results: One patient (3%) was cured, 22 patients (73%) showed improvement, and 7 patients (23%) showed no change or aggravation after the treatment. One patient was lost to follow-up. Nineteen patients (61%) had one or more complications, including skin necrosis in 14 patients (45%), bullae in 7 patients (23%), joint stiffness or contracture in 6 patients (19%), and transient nerve palsy in 4 patients (13%). All of the complications were resolved completely after 1 to 8 months' (average, 3.4 months) follow-up, except in 2 patients who underwent amputation. According to the location of AVMs, rates of therapeutic benefit and complications were 93% and 64% in the group involving fingers, 38% and 78% in the group involving fingers and the palm, and 88% and 38% in the group involving the palm, respectively.

Conclusion: Ethanol embolotherapy of hand AVMs improves symptoms in a certain percentage of patients with a relatively high risk of complications. According to the extent of AVMs, there was a trend toward a higher complication rate in treatment of AVMs involving fingers and a lower rate of therapeutic benefit in AVMs involving both the fingers and the palm.