Congenital vascular malformations in the hand and forearm

Purpose: To review a single-center experience in the management of symptoma tic congenital vascular malformations of the hand and forearm with special attention to embolotherapy. Methods: A retrospective chart review was performed to identify patients wi th vascular malformations referred for arteriography and possible intervent ion between 1983 and 1998. Arteriography and venography were performed in a ll patients to differentiate between true high-flow arteriovenous malformat ions (AVM) and low-flow primary venous malformations (PVM). The clinical an d radiological data, procedural results, and follow-up data were retrieved and reviewed. Results: In a 15-year period, 39 patients (22 men; mean age 22.5 years, ran ge 1-51) had symptomatic vascular lesions diagnosed in the forearm and hand : 21 AVMs, 17 PVMs, and one complex lesion with both AVM and PVM. Thirty-fo ur (87%) lesions were treated with immediate technical success achieved in 31 (91%) cases; 5 (13%) lesions were not amenable to percutaneous treatment . There were no major complications, but 3 embolized AVMs had significant r esidual flow (81.6% technical success on intention to treat basis). Long-te rm follow-up ranging to 5 years was available in 26 of the 34 treated patie nts; the mean symptom-free period was 30 months for the AVM patients and 30 .5 months for the PVM group, with an average of 1.5 and 1.2 embolization pr ocedures, respectively. Conclusions. Vascular malformations of the hand and forearm are extremely r are lesions that demand a multidisciplinary approach for optimal diagnosis and management. Microembolotherapy with or without surgery has offered the highest level of safety and success to date.