Management of Arteriovenous Malformation: A Retrospective Review of 52 Cases

Background and goal of study Arteriovenous malformation (AVM) is relatively uncommon. Its pathogenesis is unknown and it has a variable presentation and clinical course. AVM may cause cosmetic and/or functional impairment that affects the quality of life. Few series are available in the literature on the treatment of AVM. Management of AVM is mainly based on personal philosophy of the treating physician. This study presents our experience in management of AVM. Our ultimate goal is to eradicate AVM by means of complete surgical excision followed by immediate reconstruction to restore the quality of life. The resection defects are reconstructed by selecting optimal techniques from a whole range of available options that replace the missing elements. In cases where complete excision is not possible without mutilating surgery a “palliative” approach is adopted to deal with life threatening situations or impairment of quality of life. Patients and methods All patients referred to our Centre for the Study and Treatment of Birthmarks in the period 1996-2010 were included in the study. Fifty-two consecutive patients with AVM culled from our prospective Vascular Anomalies Database were reviewed retrospectively. Main findings Five patients presented with Schöbinger stage I AVM, 33 patients with a stage II and 14 patients with stage III AVM. 45 patients were managed at our institution. 23 of these 45 patients were treated surgically. 22 of these 23 patients with 23 AVMs were treated surgically with curative intent and in one patient a “palliative” approach was chosen. 11 of the 23 surgically treated patients underwent pre-operative intra-arterial embolisation. 17 defects required one or multiple reconstruction-technique(s) to restore form and function. Two AVMs recurred in two patients, one of whom had two lesions excised. There was no recurrence of the AVM in the remaining 20 patients (mean follow-up of 51 months). The AVM was stable over 4 years in one patient who was surgically treated with a “palliative” approach. The remaining patients were either managed conservatively or treated with alcohol embolisation. Conclusion AVM is a heterogeneous in presentations, symptoms, location and stage. A multidisciplinary approach is vital to achieve optimal outcome. Complete surgical resection with or without pre-operative intra-arterial embolisation is necessary to prevent recurrence of AVM. Reconstruction is an important part of surgical treatment of AVM. Our recurrence rate is favourable as compared to recurrence rates of previous studies.