Periocular arteriovenous malformations: clinical classifications and treatment strategies
10.3760/cma.j.cn114453-20200305-00118
- VernacularTitle:眼周动静脉畸形：临床分型和治疗策略
- Author:
Xi YANG
1
;
Yunbo JIN
;
Chen HUA
;
Yuanbo LI
;
Hechen JIA
;
Hui CHEN
;
Gang MA
;
Xiaoxi LIN
Author Information
1. 上海交通大学医学院附属第九人民医院整复外科血管瘤与脉管畸形中心 200011
- Keywords:
Arteriovenous malformation;
Periocular;
Classification;
Absolute ethanol;
Interventional embolization;
Surgical treatment
- From:
Chinese Journal of Plastic Surgery
2020;36(4):368-374
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study proposed a new clinical classification and treatment strategies for periocular arteriovenous malformation (AVM).Methods:A retrospective analysis of the cases of periocular AVM from Jan 2015 to Jan 2019 was included in this study. According to the DSA angiography results, which type of the ophthalmic artery connected with the AVMs, three types of classification were initiated: type 1 is unilateral ophthalmic artery blood supply the lesion and the central retinal artery is not involved; type 2 is bilateral ophthalmic artery blood supply and the central retinal artery is not involved; type 3 is unilateral or bilateral ophthalmic artery blood supply and the central retinal artery is involved. Type 3 can be subdivided into 3a and 3b subtypes according to the visual acuity of the affected eye. Type 3a is the presence of vision; type 3b is the loss of vision. Type 1 patients were treated with super-selective onyx embolisation of the feeding arteries of AVMs through the ocular arteries and then treated with ethanol embolotherapy; Type 2 patients were treated with bilateral super-selection onyx embolisation of the feeding arteries of AVMs through the ocular arteries and then were treated with ethanol embolotherapy; type 3a patients were treated with ethanol embolotherapy combined with surgery; type 3b patients were treated with enucleation and orbital reconstruction.Results:There were 32 cases in this study. For 6 cases of type 1, The treatment course was 1-5 sessions, with an average of 2.1 sessions. 5 cases were cured, 1 case was improved, 1 case occured minor complication (superficial tissue necrosis), which was self-healing; In 8 cases of type 2, 4 cases were treated with interventional therapy for 1-7 sessions, with an average of 2.5 sessions. 3 cases were cured, 5 cases were improved, 1 case had minor complication (superficial tissue necrosis). Among the 4 cases treated by operation, 3 cases were repaired by expanded flap, 1 case by local flap. 1 case was cured, and 3 cases was improved, without operation related complications; In 13 cases of type 3a, 3 cases was cured, 10 cases was improved, 2 cases had intervention therapy related minor complications (superficial tissue necrosis) which was self-healed, 1 case had operation related complications (small area necrosis of flap, necrosis area was treated by dressing). In 5 cases of 3b type, 2 cases were cured, 3 cases were improved, and 1 case had operation related complication (partial necrosis of flap, thedefect was further repaired by skin grafting).Conclusions:The classification of periocular arteriovenous malformations has its significance for guiding the selection of treatment strategies. Combining ethanol embolotherapy, neurological intervention techniques, and plastic and reconstructive techniques are essential to achieve better clinical outcome in the treatment of periocular AVM with minimal complications.
