Treatment and Prognosis in Congenital Arteriovenous Malformation of the Extremity

Abstract

This retrospective study was designed to determine the location, symptoms, and long-term results of surgical versus medical therapy in congenital arteriovenous malformation of the extremity. In reviewing all such case records at the Mayo Clinic for the years 1931 through 1980 we found 100 females and 85 males with 74% of lesions in the lower extremity, 22% in the upper extremity, and 4% in combination. Less than 1% were asymptomatic, while 43% had skin discoloration followed by 37% having pain as the presenting complaint. Cases with secondary congestive heart failure, while rare (3%), had a high associated mortality. Regarding treatment and prognosis, asymptomatic patients rarely progressed in severity. Medical therapy rarely (8%) yielded significant improvement and most frequently resulted in an unchanged condition. Conversely, surgery resulted in improvement in 48% of cases with worse results occurring about as frequently as with medical treatment (4% vs. 5% respectively). Surgery furthermore did not result in lesion recurrence more than non-surgical treatment. Multiple operations can be anticipated in some cases, with good outcome as a final result. We conclude that congenital arteriovenous malformations do not progress unrelentingly, and that surgery often has a better result than non-surgical treatment.