Endovascular Treatment of Arteriovenous Malformations of the Head and Neck: Focus on the Yakes Classification and Outcomes |
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| Affiliation: | 1. Department of Radiology, University of Michigan, Ann Arbor, Michigan;2. Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;3. Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan;1. Department of Radiology, Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico;2. Adient Medical, 12234 Shadow Creek Parkway, Building 8, Pearland, TX 77584;3. Department of Radiology, Medical Clinic of Houston, Houston, Texas;4. Department of Radiology, Stanford University, Stanford, California;5. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas;1. Department of Radiology, San Raffaele Scientific Institute, Milan, Italy;2. Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy;3. Department of Radiology and Vascular Surgery, Vita-Salute San Raffaele University, Milan, Italy;1. Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104;2. Department of Pathology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104;3. Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104;1. Department of Surgery, Lenox Hill Hospital, Northwell Health System, New York, NY;2. The AVM Center of New York at Lenox Hill, Northwell Health System, New York, NY |
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| Abstract: | PurposeTo evaluate endovascular treatment of head and neck arteriovenous malformations (AVMs) based on the Yakes AVM classification and correlate treatment approach with clinical and angiographic outcomes.Materials and MethodsA retrospective single-center study was performed in patients who underwent endovascular treatment of head and neck AVMs between January 2005 and December 2017. Clinical and operative records, imaging, and postoperative courses of patients were reviewed. Clinical stage was determined according to the Schobinger classification. AVM architecture and treatment approaches were determined according to the Yakes classification. Primary outcomes were clinical and angiographic treatment success rates and complication rates, with analysis according to the Yakes classification.ResultsA total of 29 patients (15 females) were identified, with a mean age of 30.6 years. Downgrading of the Schobinger clinical classification was achieved in all patients. Lesions included 8 Yakes type IIa, 5 type IIb, 1 type IIIa and IIIb, and 14 type IV. Lesions were treated using an intra-arterial, nidal, or transvenous approach, using ethanol and liquid embolic agents. Arteriovenous shunt eradication of >90% was achieved in 22 of 28 patients (79%), including 9 of 13 (69%) of Yakes type IV lesions and 13 of 15 (87%) of the other types. There were 5 significant complications in 79 procedures (6%), including 4 of 50 (8%) in Yakes type IV lesions.ConclusionsSchobinger stage was downgraded in all patients. Arteriovenous shunt eradication of >90% was achieved in most patients. Yakes type IV lesions required more sessions, and shunt eradication was higher in the Yakes II and III groups. |
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| Keywords: | AVM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0015" }," $$" :[{" #name" :" text" ," _" :" arteriovenous malformation |
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