Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Orphanet Journal of Rare Diseases
Published in: Orphanet Journal of Rare Diseases 1/2024

Open Access 01-12-2024 | Arteriovenous Malformation | Research

Ethanol embolization of arteriovenous malformations in the buttock: ten-year experiences in diagnoses and treatment options

Authors: Yuchen Shen, Deming Wang, Xindong Fan, Lianzhou Zheng, Lixin Su, Xitao Yang

Published in: Orphanet Journal of Rare Diseases | Issue 1/2024

Login to get access

Abstract

Background

Clinically, arteriovenous malformations in the buttocks (bAVMs) are extremely rare. Our study aimed to evaluate the efficacy and safety of ethanol embolotherapy in managing bAVMs.

Results

A total of 32 patients with bAVMs (14 females and 18 males) from 2012 to 2021 were included in this study. All patients underwent complete clinical and imaging examinations. Further, the AVMs lesions were analyzed according to Schöbinger staging and Yakes classification. Each patient had undergone a multistage ethanol embolization. The amelioration of clinical symptoms and devascularization on angiography were evaluated at regular follow-ups. In the present cohort, the 11–20 age group had the most patients (15/32; 46.88%). A total of 124 embolization procedures were performed (average 3.88 procedures per patient), and the average dose of absolute ethanol was 18.96 mL per procedure. Thirteen patients with dominant draining veins underwent additional coil deployment before ethanol embolization (13/32; 40.63%). During follow-ups, clinical improvement was found in 23 of 27 who presented with a pulsating mass (85.19%), 17 of 20 with abnormal local skin temperature (85%), 5 of 6 with bleeding (83.33%), and 5 of 5 patients treated for pain (100%). More than 75% angiographic devascularization was achieved in 18 patients (18/32; 56.25%). Finally, 12 out of 13 patients (92.31%) reduced from Schöbinger Stage III to a lower grade, and ten patients exhibited a complete response (10/32; 31.23%). There was a single serious complication of local necrosis, while neither paranesthesia nor infection was observed postoperatively.

Conclusions

Ethanol embolization assisted with coils can treat bAVMs effectively and safely. The Yakes classification contributed to the optimal ethanol embolotherapy of bAVMs.
Literature
1.
Shen Y, Wang Z, Yang X, Zheng L, Wen M, Han Y, et al. Novel classification for simple peripheral arteriovenous malformations based on anatomic localization: prevalence data from the tertiary referral center in China. Front Cardiovasc Med. 2022;9:935313.CrossRefPubMedPubMedCentral
2.
Lee BB, Baumgartner I, Berlien HP, Bianchini G, Burrows P, Do YS, et al. Consensus document of the international union of angiology (IUA)-2013. Current concept on the management of arterio-venous management. Int Angiol. 2013;32(1):9–36.PubMed
3.
Ishihara T, Hirooka M, Ono T. Arteriovenous malformation in the buttock: treatment with a combination of selective embolization and excision. J Dermatol. 1997;24(12):787–92.CrossRefPubMed
4.
Strubing FF, Porubsky S, Bigdeli AK, Schmidt VJ, Krebs L, Kneser U et al. Interdisciplinary management of peripheral arteriovenous malformations: review of the literature and current proceedings. J Plast Surg Hand Surg. 2022;56(1):1–10.
5.
Fan XD, Su LX, Zheng JW, Zheng LZ, Zhang ZY. Ethanol embolization of arteriovenous malformations of the mandible. AJNR Am J Neuroradiol. 2009;30(6):1178–83.CrossRefPubMedPubMedCentral
6.
Su LX, Li XY, Zhao ZJ, et al. Absolute ethanol embolization of lip arteriovenous malformations: observational results from 10 years of experience. J Vasc Interv Radiol. 2022;33(1):42–e84.CrossRefPubMed
7.
Han Y, Fan X, Su L, Wang Z. Absolute ethanol embolization combined with surgical resection of scalp arteriovenous malformations: interim results. J Vasc Interv Radiol. 2018;29(3):312–9.CrossRefPubMed
8.
Li X, Su L, Yang X, Han Y, Wang D, Zheng L, et al. Embolotherapy for high-flow arteriovenous malformations in the hands using absolute ethanol with coil-assisted dominant outflow vein occlusion. J Vasc Interv Radiol. 2019;30(6):813–21.CrossRefPubMed
9.
Yang XT, Su LX, Fan XD. Intraosseous arteriovenous malformations in the extremities managed with coils and absolute ethanol treatment. Ann Vasc Surg. 2020;65:152–9.CrossRefPubMed
10.
Kim R, Do YS, Park KB. How to treat peripheral arteriovenous malformations. Korean J Radiol. 2021;22(4):568–76.CrossRefPubMed
11.
Ryu JY, Kim YH, Lee JS, Lee JW, Oh EJ, Kim HM, et al. Oscillatory shear stress promotes angiogenic effects in arteriovenous malformations endothelial cells. Mol Med. 2021;27(1):31.CrossRefPubMedPubMedCentral
12.
Wang D, Su L, Han Y, Fan X. Ethanol embolotherapy of high-flow auricular arteriovenous malformations with electrolytically detachable coil-assisted dominant outflow vein occlusion. Eur J Vasc Endovasc Surg. 2014;48(5):576–84.CrossRefPubMed
13.
Standring S, Gray H. Gray’s anatomy: the anatomical basis of clinical practice. Forty-second edition. ed. Amsterdam: Elsevier; 2021. xvii, 1588 pages p.
14.
Yakes WF, Vogelzang RL, Ivancev K, Yakes AM. New arteriographic classification of AVM based on the Yakes classification system. Congenital Vascular Malformations. 2017.
15.
Saguchi T, Yasunori A, Seiji K, Atsushi K, Kazuhiro S. Guidelines for absolute ethanol for use in vascular embolization, 2016 edition. Interventional Radiol. 2018;3:44–65.CrossRef
16.
Griauzde J, Wilseck ZM, Chaudhary N, Pandey AS, Vercler CJ, Kasten SJ, et al. Endovascular treatment of arteriovenous malformations of the head and neck: focus on the Yakes classification and outcomes. J Vasc Interv Radiol. 2020;31(11):1810–6.CrossRefPubMed
17.
Bouwman FCM, Botden S, Verhoeven BH, Schultze Kool LJ, van der Vleuten CJM, de Blaauw I, et al. Treatment outcomes of embolization for peripheral arteriovenous malformations. J Vasc Interv Radiol. 2020;31(11):1801–9.CrossRefPubMed
18.
Centeno RF, Sood A, Young VL. Clinical anatomy in aesthetic gluteal contouring. Clin Plast Surg. 2018;45(2):145–57.CrossRefPubMed
19.
Kanawati AJ. Variations of the sciatic nerve anatomy and blood supply in the gluteal region: a review of the literature. ANZ J Surg. 2014;84(11):816–9.CrossRefPubMed
20.
Lokhorst MM, Jolink F, Horbach SER, Spuls PI, van der Horst C. Surgical treatment of peripheral vascular malformations: a systematic review and meta-analysis. Plast Reconstr Surg. 2021;147(5):1149–61.CrossRefPubMed
21.
Leonardi M, Simonetti L, Cenni P, Raffi L. Brain AVM embolization with onyx(R): analysis of treatment in 34 patients. Interv Neuroradiol. 2005;11(Suppl 1):185–204.CrossRefPubMedPubMedCentral
22.
Lv X, Wu Z, Li Y, Yang X, Jiang C. Hemorrhage risk after partial endovascular NBCA and ONYX embolization for brain arteriovenous malformation. Neurol Res. 2012;34(6):552–6.CrossRefPubMed
23.
Li TL, Fang B, He XY, Duan CZ, Wang QJ, Zhao QP, et al. Complication analysis of 469 brain arteriovenous malformations treated with N-butyl cyanoacrylate. Interv Neuroradiol. 2005;11(2):141–8.CrossRefPubMedPubMedCentral
24.
See AP, Mohammaden MH, Rizko M, Stapleton CJ, Amin-Hanjani S, Charbel FT, et al. Morbidity and mortality associated with sequential flow reduction embolization technique of cerebral arteriovenous malformations using n-butyl cyanoacrylate. J Neurointerv Surg. 2021;13(3):237–41.CrossRefPubMed
25.
Soulez G, Gilbert Md Frcpc P, Giroux Md Frcpc MF, Racicot Md Frcpc JN, Dubois J. Interventional management of arteriovenous malformations. Tech Vasc Interv Radiol. 2019;22(4):100633.CrossRefPubMed
26.
Housley SB, Cappuzzo JM, Waqas M, Levy EI. Facial arteriovenous malformation embolized using n-Butyl-2 cyanoacrylate and contrast stasis rather than tantalum powder with double flow arrest to prevent skin discoloration: a technical note. World Neurosurg. 2022;164:350–2.CrossRefPubMed
27.
Hayakawa M, Ao T, Nagakura K, Fujioka T, Nakamura H, Ido K. Intra-arterial injection therapy with ethanol for a patient with renal arteriovenous fistula. Hinyokika Kiyo. 1984;30(8):1069–74.PubMed
28.
Le Dare B, Gicquel T. Therapeutic applications of ethanol: a review. J Pharm Pharm Sci. 2019;22(1):525–35.CrossRefPubMed
29.
Shen Y, Wang D, Wen M, Di R, Fan X, Su L, et al. Coil-assisted ethanol embolotherapy for refractory head and neck arteriovenous malformations with Onyx recrudescence: 10-Year experiences. J Vasc Surg Venous Lymphat Disord. 2023;11(6):1219–1230.
30.
Khurana A, Hangge PT, Albadawi H, Knuttinen MG, Alzubaidi SJ, Naidu SG et al. The use of transarterial approaches in peripheral arteriovenous malformations (AVMs). J Clin Med. 2018;7(5).
31.
Dorrity J, Mack J, Wong K, Richter GT. Multimodality treatment of vascular anomalies of the head and neck. J Oral Pathol Med. 2022.
32.
Jeter J, Wong E. Hyperbaric oxygen therapy in dermatology. Cutis. 2020;105:24–7.PubMed
33.
Queisser A, Seront E, Boon LM, Vikkula M. Genetic basis and therapies for vascular anomalies. Circ Res. 2021;129(1):155–73.CrossRefPubMed
34.
Fernandez-Alvarez V, Suarez C, de Bree R, Nixon IJ, Makitie AA, Rinaldo A, et al. Management of extracranial arteriovenous malformations of the head and neck. Auris Nasus Larynx. 2020;47(2):181–90.CrossRefPubMed
Metadata
Title
Ethanol embolization of arteriovenous malformations in the buttock: ten-year experiences in diagnoses and treatment options
Authors
Yuchen Shen
Deming Wang
Xindong Fan
Lianzhou Zheng
Lixin Su
Xitao Yang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Orphanet Journal of Rare Diseases / Issue 1/2024
Electronic ISSN: 1750-1172
DOI
https://doi.org/10.1186/s13023-024-03205-x

Other articles of this Issue 1/2024

Orphanet Journal of Rare Diseases 1/2024 Go to the issue

Research

Structural brain abnormalities in Pallister-Killian syndrome: a neuroimaging study of 31 children

Correction

Correction: The impact of osteogenesis imperfecta severity on oral health-related quality of life in Spain: a cross-sectional study

Position statement

A position statement on the post gene-therapy rehabilitation of aromatic I-amino acid decarboxylase deficiency patients

Research

Dual rare genetic diseases in five pediatric patients: insights from next-generation diagnostic methods

Research

Patients’ and physicians’ awareness of clinical symptoms and disease severity in tuberous sclerosis complex

Research

Methodological advances in patient-centered rare disease research: the UTHealth Houston Turner Syndrome Society of the United States research registry