Clinical studyExtremity Arteriovenous Malformations Involving the Bone: Therapeutic Outcomes of Ethanol Embolotherapy
Section snippets
Patients
Approval from the institutional review board of our hospital was obtained for a retrospective review of patient medical records, but informed consent was not required. Written consent for the procedures was obtained from all patients.
From December 1996 to May 2009, 125 patients with AVMs in the extremities were referred to our vascular malformation clinic. AVMs with severe overlying skin ulceration and infection and AVMs in a nonfunctioning extremity were contraindications to ethanol
Results
In 125 patients with extremity AVMs, 22 patients (17.6%) had bony involvement of AVMs in the extremities. There was multiple bone involvement in eight patients (36%). During the 96 ethanol embolotherapy procedures performed (range, 1–12; mean, 4.4), the amount of ethanol used ranged from 4 mL to 65 mL and the total dose did not exceed 1 mL/kg body weight in a single session.
Discussion
Primary bone AVMs account for fewer than 1% of all primary intraosseous lesions (21, 22). The incidence and clinical manifestations of extremity AVMs involving the bone are not well known. In the present study, 17.6% of extremity AVMs (22 of 125) had bony involvement, with multiple bone involvement in eight patients (36%). The most common clinical symptom or sign was pain (68%), followed by mass effect with pulsatility (41%), swelling of the extremity (23%), bone overgrowth of more than 2 cm
Acknowledgments
The authors thank Wayne F. Yakes, MD, for his invaluable technical assistance.
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None of the authors have identified a conflict of interest.