Endovascular Treatment of Peripheral Arteriovenous Malformations (AVMs): Do Angiographic Outcomes Relate to the Quality of Life?

PURPOSE: Patients with arteriovenous malformations (AVMs) have a lower health-related quality of life (QoL) than the general population. QoL assessment of patients with peripheral AVMs after endovascular treatment is scarce in the literature. Radiologic and clinical outcomes are not always correlated in vascular malformation treatment. This study aimed to investigate the relationship between clinical outcomes, QoL, and angiographic outcomes. MATERIALS AND METHODS: Patients with peripheral AVM that underwent endovascular treatment between January 2009 and December 2021 in a single center were retrospectively evaluated. Patients' characteristics (age, sex), AVM characteristics (Schobinger classification, location, angiographic architecture), previous treatment, treatment characteristics (type of endovascular approach, embolizing agent and number of sessions), percentages of angiographic response, complications, and recurrence were evaluated. The angiographic architecture was evaluated according to the Yakes classification. The questionnaire was applied for evaluation of clinical response and QoL. Patients older than 12 years and those who can be contacted were included in clinical and QoL analysis. Clinical response was defined as improvement in the patient's most important pretreatment symptom. Treatment response was defined as clinical response plus >50% angiographic response. RESULTS: Eighty-six patients (41 males [47.7%], 45 females [52.3%]) were included in angiographic analysis. The mean age was 28.44±12.99 years (range=5-61). Forty-three patients (50%) had previous treatment. The median number of sessions was 2 (range 1-15, InterQuartile Range [IOR]=2). Sixty-one patients (30 males [49.2%], 31 females [50.8%]) were included in clinical analysis. The clinical response rate was 73.8%, 95% confidence interval (CI) [0.60, 0.84]. The treatment response rate was 45.9%, 95% CI [0.33, 0.59]. The complication rate was 8.2%. Before treatment, 48 patients (78.7%) reported a negative impact on their QoL. Thirty-three of 48 patients (68.8%) reported improvement on their QoL after treatment. Higher Schobinger stages were related to a negative impact on QoL before treatment (p<0.01). Yakes types were not related to QoL (p=0.065). Clinical response was related to improvement on QoL after treatment (p<0.01). Angiographic and treatment responses were not related to improved QoL after treatment (p=0.52 and p=0.055, respectively). CONCLUSION: Angiographic architecture and outcomes were not always reflected in QoL after endovascular treatment. CLINICAL IMPACT: This study's findings will help clinicians with what to focus on in AVM treatment and how to monitor patients with peripheral AVM after endovascular treatment. Rather than relying too much on the angiographic response, patients should be checked for symptoms and quality of life improvement. No clear data in the literature regarding the applicability of the Yakes Classification in patients with previous treatment. This study questioned the applicability of the Yakes Classification in patients with previous treatments. In this study, type 4 AVMs were more common in patients with previous treatment.

A novel technique for the non-surgical management of inadvertent bowel catheterization during percutaneous abscess drainage: a technical note

Percutaneous abscess drainage-related inadvertent bowel catheterization is an undesired complication that requires treatment. In two cases without signs of peritonitis that we examined, it was possible to achieve successful abscess drainage, and to treat abscess-related inadvertent bowel catheterization by using a novel technique without surgery.

Clinical results of polidocanol sclerotherapy in venous malformation treatment: Patient-perceived improvement and satisfaction.

PURPOSE: This study evaluated the results of polidocanol sclerotherapy in the treatment of venous malformations (VM) including patient satisfaction, perceived improvement, and predictors of satisfaction. MATERIAL AND METHOD: Patients with VM that underwent polidocanol foam sclerotherapy between June 2013 and July 2021 in a single center were retrospectively evaluated. Patient demographics, VM, and treatment characteristics were analyzed. Patient-reported outcomes and satisfaction were analyzed with a questionnaire. RESULTS: This study included 232 (136, 58.6%, female) patients. The mean age was 24.49 ± 12.45 years (range 3-72). The clinical response rate was 82.3%. The rate of satisfaction was 82.3%, and 116 (50%) patients were significantly satisfied. There were no major complications. Clinical response and VM margin were related to satisfaction (p < 0.01, p = 0.012, respectively). Clinical response to pretreatment swelling was related to significant satisfaction (p = 0.02). CONCLUSION: Polidocanol sclerotherapy was safe and effective in VM treatment with high satisfaction and low complication rates.

Endovascular management of renal angiomyolipomas: Do coils have a benefit in terms of clinical success rates?

PURPOSE This study evaluated single center results of endovascular treatment in renal angiomyolipoma (AML) to determine whether there is clinical relevance of adding proximal coil embolization to distal particle embolization in terms of safety, efficacy and retreatment rates. METHODS A retrospective analysis was performed to evaluate patients undergoing transarterial embolization for renal AMLs from January 2007 to October 2020. Parameters regarding patient and tumor characteristics, embolization technique, treatment outcome and complications were recorded. Patients were divided into two groups as A (only particle group) and B (particle + coil group) based on the type of embolic agent used for treatment. Comparative analysis was performed between the two groups in terms of tumor size reduction, retreatment and complication rates. RESULT Forty-two patients (37 (88.1%) female, 5 (11.9%) male) harboring 48 AMLs were included in the study. The mean age was 43.46 (range 20 to 78). The technical success rate was 95.8% (46 of 48 procedures). The mean size reduction was 1.94±1 cm (p < 0.001) after treatments however, no significant difference was seen between groups in terms of tumor size reduction. Retreatment rates were 3.1% (1 of 32 cases) in group A and 14.3% (2 of 14 cases) in group B (p = 0.21). No significant difference was found between groups in terms of bleeding and complication rates during the perioperative period. Mean follow-up duration was 26.48±25.71 (range from 2 to 102) months. CONCLUSION In this study, no clear supplementary benefit was observed in terms of safety, and efficacy with the adjunction of coils to distal particle embolization in the management of AMLs.

Stent-assisted coiling of cerebral aneurysms with the Neuroform Atlas stent.

Objectives The Neuroform Atlas stent (AS) is the smallest intracranial stent with an open-cell design. This study reports the first clinical experience with AS. Methods All intracranial aneurysms treated by stent-assisted coiling using a single AS in a single institution were retrospectively evaluated. Patient demographics, aneurysm characteristics, angles between the parent artery and stented branch, technical success, and clinical and angiographic follow-up were analyzed. Results Fifty-five consecutive aneurysms treated with AS-assisted coiling were included. Of these, 69.1% were located distal to the circle of Willis. Technical success rate was 100%. The mean diameters of proximal and distal parent arteries were 2.62 mm (range 1.5-4.4) and 1.8 mm (range 0.8-3.5), respectively. Except for a minor stroke in a patient who completely discontinued antiplatelet therapy on postoperative day 4, there were no clinical events with permanent sequelae, and 94.1% of patients had Raymond-Roy score of 1 or 2 aneurysmal occlusion at a mean follow-up duration of 7.9 months. Although the angle between the parent artery and the stented branch increased significantly ( p < 0.001) with time, the angular change at follow-up was only 16.45 ± 11.03 degrees and was inversely correlated both with preoperative angle and the diameter of the distal parent artery ( r = -0.465 and r = -0.433, respectively, p = 0.004 for both). Conclusion AS-assisted coiling was associated with a favorable early clinical outcome and angiographic results in this series. This stent can be used for distally located aneurysms and results in minimal alteration of the arterial anatomy.