Arteriovenous malformations: a review of 200 cases.

Objective, The aim of this study was to analyze the natural history of arte riovenous malformations by reviewing 200 consecutive cases observed in all localizations between 1992 and 1996 in a multidisciplinary angioma clinic. Patients and methods. Files concerning 200 arteriovenous malformations were reviewed with a standardized observation sheet applying the severity crite ria defined by the International Society for the Study of Vascular Anomalie s. We used the Schobinger staging system which includes 4 grades of severit y: grade I = dormancy, grade II = expansion, grade III = destruction, grade IV = cardiac decompensation. Results. There was no predominance by gender. Cephalic localizations were t he most common. The malformation was present at birth as indicated by histo ry taking in 40 p. 100 of the cases. Progression during childhood (grade II ) was observed in 84 p. 100. At the first consultation, the patients genera lly were more often in grade II than in grade I or III. Bone destruction wa s observed in 3 cases, signs of cardiac decompensation in 5. Arteriovenous malformations were part of a more complex syndrome in 9 cases. We noted a f lare-up in the prepuberty or puberty period in 75 p. 100 of the cases and t he possible role of puberty (64 cases), trauma (39 cases) and pregnancy (25 p. 100 of the adult women). Explorations were generally completed (Doppler , arteriography) by grade II, expressing the need for a map of expanding le sions. Finally it was difficult to assess posteriorly the beneficial or del eterious effect of the often multiple treatments prescribed for these patie nts. Discussion. The review of these 200 cases pointed out the "pediatric" natur e of the problem of arteriovenous malformations in the large majority of th e cases and the often misleading presentation of these vascular anomalies, particularly grade I malformations. A false aspect of capillary malformatio n could raise the risk of inappropriate treatment. This review also confirm ed known factors of exacerbation (puberty, pregnancy, trauma) and demonstra ted the severity of these vascular anomalies which can progress with loco-r egional expansion and invasion without a cellular proliferation component. The analysis of treatments used showed that embolization alone cannot defin itively and totally control a superficial arteriovenous malformation and th at no one treatment, even combined embolization and large excision, can be a guarantee to provide total cure.