Angiographic Classification and Embolotherapeutic Outcome of High-Flow Arteriovenous Malformations of the Body and Extremities: 4 Years Experience in Ramathibodi Hospital

Objective: To determine angiographic classification of the high-flow peripheral AVMs and to assess embolotherapeutic outcome in Ramathibodi Hospital. Materials and Methods: Data from angiograms of the 16 consecutive patients with 18 AVMs were classified by two independent interventionists according to Cho et al classification into arteriovenous fistulae (type 1), arteriolovenous fistulae (type Il), arteriolovenulous fistulae with non-dilated fistula (type Illa) and arteriolovenulous fistulae with dilated fistula (type Illb). The embolotherapeutic outcome was assessed into cure, partial remission, no remission and aggravation. Complications were determined into major and minor conditions. Result: For classification in 18 AVMs, 55.6% were type Illb, 16.7% were Illa, 16.7% were type Il, 5.6% were combined type | and Illb and 5.6% were combined type Illa and Illb. The embolotherapeutic outcome was assessed in 12 AVMs that 75 % were partial remission and 25 % had no remission. One patient had major complication (ulna artery dissection). Others had minor complications including pain, skin necrosis and transient erection of penis. Conclusion: Type Illb AVM was found as the most common type of high-flow peripheral AVMs. Transcatheter arterial embolization with/without superselection is a primary therapeutic modality in management of patients with peripheral AVM to improve, possible cure or as a presurgical intervention to reduce bleeding and maximize successful resection.