Student University of Alabama at Birmingham, United States
Purpose: Arteriovenous malformations (AVMs) are aberrant vascular connections. Management frequently involves the use of liquid embolic or sclerosing agents; however, comparative data regarding efficacy remain limited. This study evaluates clinical outcomes of different embolization and sclerotherapy approaches for peripheral AVMs.
Materials and Methods: A retrospective review was performed of peripheral AVMs treated at a tertiary pediatric and affiliated adult hospital between 2010 and 2025. Patients with intracranial AVMs or who underwent exclusive surgical management were excluded. Treatments utilized liquid embolic agents—n-butyl cyanoacrylate (NBCA), or ethylene vinyl alcohol copolymer (EVOH); sclerosing agents—sodium tetradecyl sulfate (STS) or ethanol; or a combination of these approaches. Efficacy was assessed angiographically—complete occlusion ( >90% reduction in flow), partial occlusion (< 90% reduction in flow), and by clinical response defined as patient-reported pain reduction and improved function. Complications were classified according to the Society of Interventional Radiology Adverse Event Classification system.
Results: Forty-nine patients underwent 78 treatment sessions. AVM lesions involved the upper extremities (33.9%), lower extremities (28.3%), abdomen (20.3%), and chest wall (17.5%). At the end of the procedure, liquid embolic agents achieved comparable rates of complete (42.9%) and partial (42.9%) occlusion, with functional improvements in 14.3% of cases. Sclerosing agents most frequently resulted in partial occlusion (55.6%), whereas complete occlusion (22.2%) and functional recovery (22.2%) occurred less commonly. Cases treated with a mixed embolic–sclerosing therapy did not yield to complete occlusions; the outcome was evenly distributed between partial occlusion (50%) and functional recovery (50%). Extremity AVMs achieved higher favorable response rates of complete occlusion (upper limb, 72%; lower limb, 68%) than abdominal (45%) or chest wall (38%) AVMs. The overall complication rate was 3.8%, consisting of a grade B nerve deficit as the major complication in 1.3% (n=1) of sessions, and grade C skin purpura and grade A skin redness as minor adverse events in 2.6% (n=2) of sessions.
Conclusion: Liquid embolic-only therapy achieved higher complete occlusion rates compared with sclerosant-only or mixed therapy approaches, while sclerosants favored partial occlusion. Across strategies, treatment of peripheral AVMs demonstrated favorable clinical outcomes with a low major complication rate (1.3%).
