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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

Diagnostic Methods, Treatment Modalities, and Follow-up of Extracranial Arteriovenous Malformations

1
Department of Cardiovascular Medicine, Vilnius University
2
Center of Reconstructive and Endovascular Surgery, Department of Vascular Surgery, Vilnius University Hospital Santariškių Klinikos
3
Department of Radiology, Nuclear Medicine and Medical Physics, Vilnius University
4
Radiology and Nuclear Medicine Center, Vilnius University Hospital Santariškių Klinikos
5
Cardiology and Angiology Center, Vilnius University Hospital Santariškių Klinikos, Lithuania
6
Department of Vascular Surgery, University of Washington, Seattle, WA, USA
*
Author to whom correspondence should be addressed.
Medicina 2012, 48(8), 58; https://doi.org/10.3390/medicina48080058
Received: 25 April 2012 / Accepted: 13 August 2012 / Published: 18 August 2012
Objective. Arteriovenous malformations (AVMs) are an uncommon vascular pathology that remains challenging to accurately diagnose and successfully treat. This study introduces a novel way to evaluate AVM treatment outcomes using transarterial lung perfusion scintigraphy (TLPS) and reports our treatment results.
Material and Methods
. The patients treated for extracranial AVMs were studied retrospectively. Diagnosis and outcomes were based on clinical data, ultrasonography, magnetic resonance imaging, computed tomography, angiography, and TLPS studies. The influence of gender; location, form, and stage of AVMs; first attempt at treatment; and treatment modalities was analyzed. Outcomes were defined as positive (cure, improvement, and remission) or negative (no remission and aggravation).
Results
. Of the 324 patients with congenital vascular malformations, 129 (39.8%) presented with AVMs, and the data of 56 treated patients with AVMs were analyzed. Of the 29 patients in the endovascularly treated group, 15 in the surgically treated group, and 12 in the combined treatment group, 24 (82.8%), 14 (93.3%), and 10 patients (83.3%), respectively, had positive outcomes (P>0.05). All outcomes were positive in surgically treated patients with extratruncular limited AVMs, and these patients were more likely to be cured as compared with those who had other forms of AVMs (OR, 5.8; 95% CI, 1.1–29; P=0.02). The patients with more advanced AVMs (stages III and IV) and with AVMs in the gluteal and pelvic region were more likely to have the worst outcomes than those with stage II AVMs (OR, 8.2; 95% CI, 1–72; P=0.03) and with AVMS in other locations (OR, 5.8; 95% CI, 1.1–29; P=0.02), respectively. Gender and age did not significantly influence treatment results (P>0.05). The TLPS data of 17 patients showed AV shunting ranging from 0% to 92%, which combined with other results helped identify 9 patients who needed further interventions, 6 who were treated successfully, and 2 who had insignificant shunting.
Conclusions
. The best outcomes were achieved in surgically treated patients with localized lesions and less advanced AVMs. For the first time in Lithuania, a modified TLPS method has been introduced that enhances a hemodynamic assessment of AV shunting and provides with a more accurate evaluation of AVMs to better serve in planning future treatments.
Keywords: congenital vascular malformations; arteriovenous malformations; diagnosis; treatment; transarterial lung perfusion scintigraphy congenital vascular malformations; arteriovenous malformations; diagnosis; treatment; transarterial lung perfusion scintigraphy
MDPI and ACS Style

Vaišnytė, B.; Vajauskas, D.; Palionis, D.; Misonis, N.; Kurminas, M.; Nevidomskytė, D.; Matačiūnas, M.; Gutauskas, M.; Laucevičius, A. Diagnostic Methods, Treatment Modalities, and Follow-up of Extracranial Arteriovenous Malformations. Medicina 2012, 48, 58.

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