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Jin Y, Zou Y, Hua C, Chen H, Yang X, Ma G, Chang L, Qiu Y, Lyu D, Wang T, Chang SJ, Qiao C, Luo C, Tremp M, Lin X. Treatment of Early-stage Extracranial Arteriovenous Malformations with Intralesional Interstitial Bleomycin Injection: A Pilot Study. Radiology 2017; 287:194-204. [PMID: 29237147 DOI: 10.1148/radiol.2017162076] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To assess the efficacy and safety of intralesional interstitial bleomycin injection in the treatment of early-stage (Schobinger stage I or II) extracranial arteriovenous malformations (AVMs). Materials and Methods This prospective study involved 34 patients with early-stage AVMs, as defined by the Schobinger staging system. The patients received intralesional interstitial bleomycin injected at a maximum dose of 15 000 IU or 1000 IU per kilogram of body weight for children who weighed less than 15 kg per procedure for a total of 6 months (once every month). Therapeutic outcome was evaluated by the degree of devascularization at angiography and the clinical outcome 3 months after the last treatment. Further follow-up was evaluated based on further clinical outcome. Adverse events were recorded according to the Society of Interventional Radiology classification. Results Of the 34 patients with early-stage AVM, 32 (mean age, 20.5 years; 24 female [75%]) completed the study. The results showed that 27 (84.4%, 95% confidence interval [CI]: 71.1, 97.7) patients were responsive to bleomycin injection, including nine (28.1%) with a complete response. Four (12.5%) patients showed no response, and one (3.1%) patient experienced worsening 3 months after the last treatment. During further follow-up (mean follow-up time, 20.7 months; range, 5-28 months), the outcome remained stable in 31 (96.9%) of the 32 patients. A major complication, anaphylactic shock, was observed in one (3.1%, 95% CI: 0, 9.5) patient. Common minor complications included hyperpigmentation, nausea, pruritus, and bullae. Conclusion Intralesional interstitial bleomycin injection is a feasible approach for early-stage AVMs and yields safe and effective outcomes. © RSNA, 2017.
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Affiliation(s)
- Yunbo Jin
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Yun Zou
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Chen Hua
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Hui Chen
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Xi Yang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Gang Ma
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Lei Chang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Yajing Qiu
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Dongze Lyu
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Tianyou Wang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Shih-Jen Chang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Congzhen Qiao
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Chunfen Luo
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Mathias Tremp
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
| | - Xiaoxi Lin
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Rd, Shanghai 200011, China (Y.J., Y.Z., C.H., H.C., X.Y., G.M., L.C., Y.Q., D.L., T.W., S.J.C., C.Q., X.L.); Department of Pediatric Surgery, Taizhou Hospital, Wenzhou Medical University, Taizhou, China (C.L.); and Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland (M.T.)
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