The Journal of Cerebrovascular and Endovascular Neurosurgery

Abstract - Original Article

Kor J Cerebrovascular Surgery. 2023 25(1): 36-49

Clinical and anatomic description of patients with arteriovenous malformation treated with endovascular therapy in a Mexican population

Mallyolo Eliezer Pelayo-Salazar1, Héctor Alfredo Montenegro-Rosales1, Jorge Luis Balderrama-Bañares1, Pablo Martínez-Arellano1, Omar Andrés Campos-Flota2, Laura Mestre-Orozco3, Julio César López-Valdés4,5

1Neurological Endovascular Therapy Department, National Neurology and Neurosurgery Institute “Dr. Manuel Velasco Suárez”, Tlalpan, Mexico City, Mexico 2Department of Geriatrics, North Central Hospital (PEMEX), Azcapotzalco, Mexico City, Mexico 3Department of Surgical Pathology, The American British Cowdray Medical Center, Cuajimalpa, Mexico City, Mexico 4Department of Neurosurgery, South Central High Specialty Hospital (PEMEX), Tlalpan, Mexico City, Mexico 5Research Department, Autonomous Tamaulipas University, Medicine Faculty of Tampico “Dr. Alberto Romo Caballero”, Tampico, Tamaulipas, Mexico

Objective: Arteriovenous malformations (AVMs) are benign congenital lesions. The estimated prevalence is 10-18 per 100,000 individuals, with an incidence rate of 1.1-1.4 per 100,000 person-year; only 12% of AVMs present symptoms during life. It is important to study different characteristics associated with AVMs because these patients require multidisciplinary treatment. Methods: A descriptive, observational, longitudinal, and retrospective study was carried out from January 15, 2016 to October 19, 2021. Convenience sampling was used on patients diagnosed with arteriovenous malformation. Sociodemographic data was obtained, such as: sex, age, site, predominant symptoms, clinical debut, type of malformation, data associated with post therapy evolution, type of embolizing agent used, associated complications, Rankin scale, and death. Results: Data from 535 procedures was collected, we calculated an incidence of 4.4 cases per million inhabitants. Ninety procedures in 56 patients that used endovascular therapy were obtained with a female-male ratio of 0.75 and an age distribution of 35±14 (SD). A 36.3±11.5 (SD) mm diameter was registered. There was a 33% success rate for endovascular surgery. Conclusions: The multidisciplinary treatment of AVMs is made up of three pillar techniques: microsurgical resection, embolization, and radio-neurosurgery. It is extremely important to make an appropriate decision, with an emphasis on achieving better functional outcomes for the patient. Although neurological endovascular therapy was initially used as an adjuvant treatment for neurosurgery and radio-neurosurgery, it has been used more and more frequently as the first line of treatment.

Key words : Arteriovenous malformation, Endovascular therapy, Coils, Embolization