Individualized Therapy for Arteriovenous Malformations in Soft Tissues: A Single-Center Retrospective Study and Discussion of Treatment Strategy.

Abstract

Background and objective: Arteriovenous malformations (AVMs) in soft tissues are uncommon congenital vascular malformations, which are challenging to treat due to the high flow, risk of uncontrollable bleeding, and infiltrative growth. Surgical resection and interventional embolization are the main treatment for AVMs. The authors aim to summarize an individualized treatment strategy for treating AVMs in soft tissues to achieve the optimal outcome.

Methods: The medical records of patients with soft tissue AVMs who were treated in our center from January of 2006 to December of 2023 were reviewed retrospectively. Treatment included surgical resection, interventional embolization, combinational therapy, bleomycin A5 injection, and copper wire retention. The treatment option for each patient was based on the Schobinger classification, the location, depth, and size of the lesion. The patients were followed up for 3 months to 5 years. The indications, precautions, complications, and outcomes of above treatment were analyzed, and the treatment strategy was hence summarized.

Results: A total of 68 patients were included in the study, including 37 male patients and 31 female patients with a mean age of 24.7 years (range: 3-62). Patients were followed up for 3 months to 5 years. Nine Schobinger stage I, 43 stage II, 14 stage III, and 2 stage IV case were included. Lesions consisted of 5 Yakes type I, 33 type II, 11 type III, and 16 type IV. Three patients could not be identified with Yakes classification due to lack of arteriographic data. Surgery alone was performed in 35 cases, including simple surgical resection with primary closure/local flap transfer (n=18), surgical resection with expanded flap reconstruction (n=7), and surgical resection followed by skin grafting (n=10). Interventional embolization alone was performed in 11 cases, including 7 cases through an intra-arterial approach and 4 cases through a direct puncture of the nidus. Ten cases underwent combinational treatment which consisted of a preoperative embolization and a subsequent surgery within 48 hours. Five cases underwent bleomycin A5 injection and 7 cases underwent copper wire retention therapy. Control (42, 61.8%) and improvement (13, 19.1%) was achieved in 68 patients (55, 80.9%). During the follow-up, 6 patients reported recurrence and received another surgery. Complications of surgical treatment included partial flap necrosis (n=5) and incision dehiscence (n=3) which healed after dress changing. No skin necrosis or ectopic embolism occurred after embolization. Sixty-six patients were very satisfied with the appearance and 2 patients were basically satisfied with the appearance.

Conclusions: The individualized therapy considering Schobinger classification, site, depth, and size of AVMs can achieve satisfactory results. Surgery and embolization are still the mainstay treatment methods for arteriovenous malformations.