Associate Professor of Interventional Radiology Rutgers - New Jersey Medical School, United States
Purpose: To produce the most comprehensive and up-to-date synthesis of medical and surgical outcomes of FAVA at the patient level.
Materials and Methods: A systematic review was done in the PubMed/MEDLINE databases following PRISMA guidelines. All studies in the English language published between 2014 and 2025 were identified. Only studies where FAVA lesions were treated were included, comprised of 27 studies (14 Retrospective; 4 Case Series; 7 Case Reports; 1 Visual Vignette; 1 Imaging Vignette). One retrospective was excluded due to probable duplication of published cases. Another retrospective seemed to have cohort overlap with another paper, so de-duplication was performed. Only unique patients who were treated were included, yielding 292 patients. Information on re-intervention (defined as further interventions to treat recurrence or lack of resolution) and follow-up outcomes, particularly pain reduction and improvement of range of motion (ROM), were extracted. Categorical outcomes (pain relief, ROM improvement, re-intervention) were compared across three modalities (cryoablation, surgery, sirolimus) using the Fisher–Freeman–Halton exact test for r×c tables (two-sided α=0.05) due to small/zero cells. When the omnibus test was significant, pairwise 2×2 Fisher’s exact tests with Holm adjustment were performed.
Results: Removing potentially duplicated subjects yielded 27 studies comprising 292 patients. 12/292 patients received combination therapy, defined as > 1 procedures delivered as part of the index course, excluding prior procedures, were excluded in analyses. 183 patients received surgical excision, with 126/130 reporting ROM improvement, 23/148 reporting re-intervention, 135/139 reporting pain reduction. 41 patients received cryoablation, with 19/21 lesions reporting ROM improvement, 8/46 lesions reporting re-intervention, 28/31 lesions reporting pain reduction. 21 patients received sirolimus with 3/5 lesions reporting ROM improvement, 0/2 re-intervention, 18/19 reporting pain reduction. ROM improved in 19/21 (90.5%) after cryoablation, 126/130 (96.9%) after surgery, and 3/5 (60.0%) after sirolimus (p=0.0075); surgery > sirolimus (Holm-adjusted p≈0.047), cryo ≈ surgery (p=0.20). Pain improved in 28/31 (90.3%) cryoablation, 135/139 (97.1%) surgical excision, and 18/19 (94.7%) sirolimus, respectively (p=0.14). Re-intervention occurred in 8/46 (17.4%) cryoablation, 23/148 (15.5%) surgical excision, and 0/2 (0.0%) (p=0.87) sirolimus.
Conclusion: Cryoablation has similar efficacy to surgical resection with similar re-intervention rates.
