Clinical ResearchTreatment of Arteriovenous Malformations Involving the Hand
Introduction
Congenital arteriovenous malformations (AVMs) are a primitive type of congenital vascular malformation that forms as the residual remnants of a developmental arrest in the early stage of embryonic life. AVMs of the hand display various clinical presentations, including heaviness, a pulsating mass, sensation of heat, pain, bleeding, ulceration, and necrosis. Furthermore, hand AVMs are likely to cause cosmetic complications and functional impairment or fracture. A large shunt can create hemodynamic alterations leading to cardiopulmonary overload and congestive heart failure.1
The lesions may or may not become clinically evident from birth to adulthood. Trauma, surgery, and hormonal influences may cause the lesion to expand hemodynamically.2
Hand AVMs are unusual and, when present, are difficult to treat because of the necessity to maintain function and there is a high complication rate after treatment. The treatments of hand AVMs include conservative treatment, embolo/sclerotherapy, partial excision, and amputation; however, there is currently no consensus for the treatment of AVMs of the hand.
The purpose of this study is to review the treatment of AVMs of the hand with embolo/sclerotherapy and surgical procedures at a single institute.
Section snippets
Material and Methods
We retrospectively reviewed the medical records and identified the patients who were referred to the vascular division owing to hand AVMs between 1995 and 2009. All the patients were collaboratively examined by a vascular surgeon and an interventional radiologist. The initial diagnostic procedure for hand AVMs, after proper obtainment of the medical history and a physical examination, included a duplex scan, Tc-99m red blood cell whole-body blood-pool scintigraphy, and computed tomography
Results
Sixty-four patients were involved in this study. The median follow-up duration was 26.9 months (range: 3.5–141.8). The median age of the patients was 31.5 years (range: 0.3–75 years). Twenty-nine (45.3%) cases were males. Lesion was clinically evident at birth in 19 cases (29.7%), and the other lesions were detected with growth of the individual. The vast majority of cases (59 cases, 92.2%) were detected before the age of 30. Ten cases (15.6%) became clinically evident or they were aggravated
Discussion
The majority of the congenital vascular malformations were treated by a multidisciplinary team approach in our institute.2 The treatment plan may be adjusted whenever a treatment strategy can be improved to deal with morbidity or recurrence. Also, treatment is commenced only when the benefit of treatment exceeds the risks involved. However, there are not yet any established guidelines for the treatment of hand AVMs. Therefore, not all hand AVMs warrant treatment nor is treatment feasible in
References (12)
- et al.
Classification and rationale for management of vascular anomalies in the upper extremity
J Hand Surg Am
(1985) New approaches to the treatment of congenital vascular malformations (CVMs)-a single centre xperience
Eur J Vasc Endovasc Surg
(2005)- et al.
Surgical treatment for congenital arteriovenous malformation: 10 years’ experience
Eur J Vasc Endovasc Surg
(2006) - et al.
Transcatheter embolization of extremity vascular malformations: the long-term success of multiple interventions
Ann Vasc Surg
(2003) - et al.
Advanced management of congenital vascular malformations: a multidisciplinary approach
Cardiovasc Surg
(2002) - et al.
Prediction of the effect of injected ethanol on pulmonary arterial pressure during sclerotherapy of arteriovenous malformations: relationship with dose of ethanol
J Vasc Interv Radiol
(2009)
Cited by (34)
Radial artery aneurysm associated with congenital arteriovenous malformation of upper extremity
2023, Journal of Vascular Surgery: Venous and Lymphatic DisordersSurgical management of vascular malformations of the upper extremity: A review of current literature
2022, JPRAS OpenCitation Excerpt :One of the 17 cases of skin necrosis resulted in autoamputation. Skin necrosis in Park et al25 was more common in diffuse malformations than in focal ones (P=0.011). This study also showed that AVMs involving subcutaneous layers had a higher risk to develop skin necrosis after embolization/sclerotherapy than malformations with no involvement of subcutaneous layers (P=0.021).
Vascular anomalies: Classification and management
2021, Handbook of Clinical NeurologyCitation Excerpt :For example, the feet are more prone to skin ulceration related to flow dependency, although one study showed that lesions < 25% of the foot area are treated more successfully (Hyun et al., 2013). Similarly, the technical success of AVM treatment in the hands is limited by the vascular anatomy and the need to maintain function (Park et al., 2012; Li et al., 2019b). The mainstay of AVF treatment focuses on the disconnection of direct arteriovenous communication.
A Vascular Malformation in the Hand with Compromised Neurologic Status
2020, Annals of Vascular SurgeryEthanol Embolotherapy for the Management of Refractory Chronic Skin Ulcers Caused by Arteriovenous Malformations
2018, Journal of Vascular and Interventional RadiologyCitation Excerpt :Other symptoms in addition to ulceration included pulsatile mass (n = 8), pain (n = 8), and bleeding (n = 10). All ethanol embolizations were performed via direct puncture techniques under general anesthesia (14,16). Superselective arteriography was performed to determine the angioarchitecture and hemodynamic features of the nidus.