Diagnostic and Interventional Radiology
Interventional Radiology - Original Article

Image-guided embolization of arteriovenous malformations of the hand using Ethylene-vinyl Alcohol Copolymer


Department of Radiology, University Hospital, LMU Munich, München, Germany


Clinic of Radiology, University Hospital Muenster, Muenster, Germany


Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany


Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany

Diagn Interv Radiol 2022; 28: 486-494
DOI: 10.5152/dir.2022.21644
Read: 387 Downloads: 122 Published: 01 September 2022

This study aimed to evaluate the safety and outcome of image-guided embolization for treating arteriovenous malformations (AVMs) of the hand using ethylene-vinyl alcohol copolymer (EVOH).

A retrospective, multicenter cohort of 15 patients with AVMs of the hand treated with 35 imageguided embolotherapies using EVOH was investigated. Clinical history, symptomatology, and imaging findings were assessed to evaluate clinical outcome (symptom-free, partial relief of pain, no improvement of pain, and clinical progression despite embolization), lesion devascularization (total, 100%; near-total, 90%-99%; substantial, 70%-90%; partial, 30%-70%; and failure, 0%-30%), and peri- and postprocedural complication rates (major complications classified according to CIRSE guidelines). Substratification analysis was performed with respect to the involvement of different anatomical compartments and the injected volume of the embolic agent.

Patients were treated for pain (93.3%), skin ulceration (46.7%), and local bleeding (33.3%). The mean number of embolotherapies was 2.3 (±1.1) in 3 patients, a planned surgical resection was conducted after embolization. Clinical outcome after a median follow-up of 18 months revealed an overall response of 11/15 patients (73.3%). Imaging at last follow-up revealed 70%- 99% reduced vascularization in 12/15 patients (80%) including 2 patients (13.3%) with a neartotal devascularization of 90%-99%. Peri- and postprocedural complications occurred in 8.5% and 31.5%, respectively, including 17.1% major complications, in 1 case requiring a previously unplanned resection. Involvement of the finger was associated with increased rates of persistent symptoms compared to the other groups (P=.049). No significant difference between the embolic agent volume injected and complication rates was found (P=.372).

Image-guided embolization using EVOH-based liquid embolic agents is effective for treating AVMs of the hand in the mid-term.

You may cite this article as: Schmidt VF, Masthoff M, Goldann C, et al. Image-guided embolization of arteriovenous malformations of the hand using EVOH. Diagn Interv Radiol. 2022;28(5):486-494.

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