The clinical application of buried-suture method in the treatment of superficial arteriovenous malformations

Abstract

Purpose

This study sought to evaluate the hemodynamic efficacy of the buried-suture method for achieving therapeutic flow reduction in superficial arteriovenous malformations (AVMs) while establishing patient selection criteria for this intervention.

Methods

Thirty patients diagnosed with superficial AVMs enrolled in this study from November 2020 to April 2023. The buried-suture procedure was performed to reduce blood flow and assist in subsequent sclerotherapy. The effectiveness of blood flow reduction was analyzed.

Results

Among the 30 patients, 19 were classified as Schobinger stage I, 7 as stage II, and 4 as stage III. Most had diffuse-type lesions (18/30, 60.0%), primarily affecting the head and neck (17/30, 56.7%). The median maximum vessel diameter within the nidus was 2.1 mm, and the median peak systolic velocity of the lesions was 65.9 cm/s. The patients underwent a median of 2.0 buried-suture procedures and 4.0 sclerotherapy sessions. All the lesions got a significant reduction of blood flow and had improved distribution grade after each buried-suture procedure (p < 0.05). In a mean follow-up of 14.11 months, only one patient experienced a skin ulcer, which healed after 2 weeks of regular dressing changes.

Conclusion

In suitable cases of superficial AVMs, the buried-suture method can effectively reduce blood flow velocity and vascular density. It could provide a safe hemodynamic foundation for subsequent sclerotherapy treatment.