Angiographic Types of Palpebral Arteriovenous Malformations and Relevant Therapeutic Options Based on Ethanol Embolization: A Multicenter Study.

IF 1.5 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Journal of Endovascular Therapy Pub Date : 2025-08-01 Epub Date: 2023-09-26 DOI:10.1177/15266028231201534
Yuchen Shen, Deming Wang, Mingzhe Wen, Lixin Su, Xindong Fan, Xitao Yang
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引用次数: 0

Abstract

Purpose: The present work aimed to determine the different angio-architectural types of palpebral arteriovenous malformations (pAVMs) and appropriate ethanol embolotherapy for each type.

Materials and methods: This was a multi-center comparative effectiveness research retrospectively conducted from November 2012 to October 2021. A total of 70 patients with pAVMs were included, which was classified into cystic pAVMs (n=29) and diffuse pAVMs (n=41) based on the angio-architecture. Of the included patients, 17 with cystic pAVMs and 13 with diffuse pAVMs underwent ethanol embolization combined with coils (CE). The remaining participants underwent no-coil ethanol embolization (NCE). Participants had undergone 60 months of follow-up. Normality of data was tested by the D'Agostino and Pearson test. Correlation was tested by the Pearson χ2 test. Deterioration-free survival (DFS) rate was estimated using the Kaplan-Meier survival analysis. Multivariate Cox regression models included variables that were significant at a p value<0.05 in the univariate analysis to screen the prognostic factor.

Results: The local symptoms of pAVMs, including pulsation, warmth, red plaque, blepharoptosis, bleeding, and visual blurring, along with the devascularizational grade of angiography were recorded before and after the respective procedures. Post-treatment complications were either evaluated at the 3-month routine follow-up or were self-reported by patients. Cystic pAVMs presented with significantly different clinical and angiographic features compared with diffuse pAVMs. With CE, patients with cystic pAVMs obtained a higher devascularizational grade (p<0.0001) and better clinical outcomes (p=0.0009) than those with diffuse pAVMs. Contrarily, with NCE, patients with diffuse pAVM had better outcomes than those with cystic pAVMs (p=0.0248). Moreover, the overall DFS rate was higher in patients with cystic pAVMs (p=0.0006). Finally, the angio-architecture of pAVMs was found to independently influence its prognosis (p=0.02).

Conclusions: In pAVMs, the angio-architectural type was associated with the relative prognostic status. Ethanol embolization combined with coils was an effective method to treat cystic pAVMs, whereas NCE was more suitable for the diffuse type, further emphasizing the importance of a type-based therapeutic strategy for pAVMs.Clinical ImpactPalpebral arteriovenous malformations (pAVMs) are rare and tricky in clinical practices. The present study has divided the pAVMs into cystic and diffuse types according to their angiographic characteristics. Ethanol embolization with (CE) or without coils (NCE) was performed on both types. CE was suitable for cystic pAVMs; whereas NCE was a better choice for diffuse pAVMs. The five-year survival analyses provided evidence of the safety and efficacy of ethanol application in pAVMs. Finally, our work demonstrated that both the short- and long-term clinical outcomes of diffuse pAVMs were poor compared to those of cystic pAVM.

脑动静脉畸形的血管造影类型及基于乙醇栓塞的相关治疗方案:一项多中心研究。
目的:本研究旨在确定不同血管结构类型的眼睑动静脉畸形(pAVM),并对每种类型进行适当的乙醇栓塞治疗。材料和方法:这是一项回顾性的多中心比较有效性研究,于2012年11月至2021年10月进行。共纳入70例pAVM患者,根据血管结构分为囊性pAVM(n=29)和弥漫性pAVMs(n=41)。在纳入的患者中,17例囊性pAVM和13例弥漫性pAVMs接受了乙醇栓塞联合线圈(CE)。其余参与者接受了无线圈乙醇栓塞(NCE)。参与者接受了60个月的随访。数据的正态性通过D’Agostino和Pearson检验进行检验。相关性采用Pearsonχ2检验。使用Kaplan-Meier生存分析来估计无恶化生存率(DFS)。多变量Cox回归模型包括p值显著的变量。治疗后并发症要么在3个月的常规随访中进行评估,要么由患者自我报告。与弥漫性pAVM相比,囊性pAVMs表现出明显不同的临床和血管造影特征。对于CE,囊性pAVMs患者获得了更高的断流分级(结论:在pAVMs中,血管结构类型与相对预后状况相关。乙醇栓塞联合线圈是治疗囊性pAVMs的有效方法,而NCE更适合于弥漫型,进一步强调了基于类型的治疗策略对pAVMss的重要性。临床影响:脑动静脉畸形(pAVMs)很罕见并且在临床实践中很棘手。本研究根据其血管造影特征将pAVM分为囊性型和弥漫性型。两种类型均采用乙醇栓塞(CE)或无线圈栓塞(NCE)。CE适用于囊性pAVM;而对于弥漫性pAVM,NCE是更好的选择。五年生存期分析为pAVMs应用乙醇的安全性和有效性提供了证据。最后,我们的工作表明,与囊性pAVM相比,弥漫性pAVMs的短期和长期临床结果都较差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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