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      Overview of peripheral arteriovenous malformations: From diagnosis to treatment methods

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          Abstract

          Based on the latest classification by the International Society for the Study of Vascular Anomalies in 2018, vascular malformations (VMs) can be categorized into simple, combined VMs of major named vessels, and VMs associated with other anomalies. Simple VMs include lymphatic, venous, capillary, and arteriovenous malformations (AVMs). AVMs represent disorders of direct arteriovenous shunts caused by the absence of a capillary bed between the involved arteries and veins. This abnormal vascular communication causes arterial blood to accumulate in the venous vessels, thus resulting in venous hypertension and characteristic clinical manifestations, such as pulsation, tremors, and elevated temperature. AVMs can occur sporadically or as manifestations of syndromic lesions and are considered among the most complex and challenging VMs. The diagnosis and treatment of AVMs can vary depending on the lesion location and associated clinical symptoms, thus complicating their management. Herein, we discuss peripheral AVMs in terms of their clinical manifestations, imaging examinations, and staging systems to provide a comprehensive reference for the treatment, evaluation methods, and follow-up procedures for this vascular anomaly.

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          Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics.

          Forty-nine specimens from a variety of vascular lesions were analyzed for cellular characteristics. Two major categories of lesions emerged from this investigation: hemangiomas and vascular malformations. This classification and its implications are justified by several considerations. Hemangiomas in the proliferating phase (n = 14) were distinguished by (1) endothelial hyperplasia with incorporation of [3H]thymidine, (2) multilaminated basement membrane formation beneath the endothelium, and (3) clinical history of rapid growth during early infancy. Hemangiomas in the involuting phase (n = 12) exhibited (1) histologic fibrosis and fat deposition, (2) low to absent [3H]thymidine labeling of endothelial cells, and (3) rapid growth and subsequent regression. The endothelium in hemangiomas had many characteristics of differentiation: Weibel-Palade bodies, alkaline phosphatase, and factor VIII production. Vascular malformations (n = 23) demonstrated no tritiated thymidine incorporation and normal ultrastructural characteristics. These lesions were usually noted at birth, grew proportionately with the child, and consisted of abnormal, often combined, capillary, arterial, venous, and lymphatic vascular elements. This cell-oriented analysis provides a simple yet comprehensive classification of vascular lesions of infancy and childhood and serves as a guide for diagnosis, management, and further research.
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            Advances in Biomaterials and Technologies for Vascular Embolization

            Minimally invasive transcatheter embolization is a common non-surgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres and liquids are available for clinical practice. Additionally, advances in biomaterials such as shape memory foams, biodegradable polymer and in situ gelling solutions have led to the development of novel pre-clinical embolic agents. The aim of this review is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field. Advances in biotechnology and material science have facilitated the development of embolic agents for vascular embolization. In this review, both clinical and pre-clinical embolic agents including mechanical occlusion devices, particulates and liquids are discussed. The challenges and future insights in this field are also highlighted. An integrated and multidisciplinary approach may offer opportunities to revolutionize the next generation of embolic agents.
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              Arteriovenous malformations of the body and extremities: analysis of therapeutic outcomes and approaches according to a modified angiographic classification.

              To propose a modified angiographic classification for peripheral arteriovenous malformations (AVMs) and to determine its value for assessing therapeutic outcomes and approaches to ethanol embolization of AVMs in the body and extremities. AVMs of the trunk and extremities were categorized according to the angiographic morphology of the nidus: type I (arteriovenous fistulae), type II (arteriolovenous fistulae), type IIIa (arteriolovenulous fistulae with non-dilated fistula), and type IIIb (arteriolovenulous fistulae with dilated fistula). Sixty-six patients (41 women; mean age 28.3 years, range 5-53) with inoperable AVMs in the body and extremities who underwent staged ethanol embolizations were retrospectively analyzed. Therapeutic outcomes and approaches were evaluated according the above classification system. The 66 AVMs were composed of 30 (45%) type IIIb, 13 (20%) type II, 12 (18%) mixed types IIIa and IIIb, 9 (14%) mixed types II and IIIb, and 2 (3%) type IIIa. Ethanol embolization was most effective for type II (100%), and more effective for type IIIb (83%) than for type IIIa or mixed types (< or = 50%). Despite the use of the transarterial approach, direct puncture and transvenous approaches were more relevant for treating type II AVMs. Only the transarterial approach was used for treating type IIIa; both direct puncture and transarterial approaches were used for treating the other types. The described angiographic classification provides considerable information concerning the characteristics of AVMs in the body and extremities, the optimal therapeutic approach, and the likely therapeutic outcome.
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                Author and article information

                Contributors
                Journal
                J Interv Med
                J Interv Med
                Journal of Interventional Medicine
                Shanghai Journal of Interventional Radiology Press
                2096-3602
                2590-0293
                29 October 2023
                November 2023
                29 October 2023
                : 6
                : 4
                : 170-175
                Affiliations
                [1]Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd, 200011, Shanghai, China
                Author notes
                []Corresponding author. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China. fanxindong@ 123456aliyun.com
                [∗∗ ]Corresponding author. Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd, Shanghai, 200011, China. wdmdeming@ 123456163.com
                [1]

                Contributed equally to this work.

                Article
                S2096-3602(23)00055-8
                10.1016/j.jimed.2023.10.006
                10831390
                4a6d23ba-13d5-4116-bc70-8c6351f8b236
                © 2023 Shanghai Journal of Interventional Radiology Press. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 24 August 2023
                : 20 October 2023
                : 21 October 2023
                Categories
                Article

                vascular anomaly,arteriovenous malformation,classification,diagnosis,treatment

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