Medical Director The Yakes Vascular Malformation Center, United States
Purpose: To determine the efficacy of Endovascular Repair of Thoracic and Shoulder Arteriovenous Malformations (AVMs). Previous reports have documented the utter futility of Onyx, Coils, and nBCA of endovascular treatment and authors plainly state these lesions are untreatable in their JVIR publications.
Materials and Methods: 16 patients (11 female, 5 male) presented for repair of shoulder and thoracic AVMs. 3 patients had extension of AVM to the supraclavicular and axillary areas. 3 patients had multiple AVMs. 7 patients had previous failed therapies (embo: PVA/coils/gelfoam; Onyx, nBCA; surgeries: excisions/arterial bypass Left subclavian Axillary, Brachial, and Radial). All patients underwent ethanol endovascular AVM repair; 4 patients had additional coil embolizations (132 treatments). Patient age range 18-76 years; mean age 36.
Results: 15 patients are cured at long-term arteriographic follow-up (follow-up 22 – 192 months; mean follow-up: 42 months). 1 patient with bilateral shoulder AVM and multiple other AVMs therapy is on-going. Complications include 2 patients with minor superficial blisters, 1 patient with transient left radial nerve injury with complete recovery and 1 patient with clot embolus to hand, Rx with urokinase w/distal 3rd phalanx removed. Thus, major complications were 2/132 procedures, 1 being transient. 1 patient at 27-year arteriographic follow-up remains cured.
Conclusion: A JVIR report of shoulder AVM endovascular repair documented total failure of the current approaches even when coupled with shoulder quadrant amputation whereby recurrence was universal. These authors stated that shoulder AVMs were not possible to treat. This report documents that cure of these difficult lesions is possible with ethanol endovascular approaches and direct puncture approaches. No other publications in the world literature documents cure of AVMs in this anatomy consistently.
Long-term cures are noted with the use of ethanol, and ethanol and coils to successfully treat these complex, problematic lesions. A low major complication rate is noted. This patient series finally documents a curative procedure for this daunting lesion.
