Abstract：
Arteriovenous malformation (AVM) recurrence after embolization was rarely reported. This study aimed to explore the potential risk factors of recurrence in angiographically obliterated AVMs treated with endovascular embolization. This study reviewed AVMs treated with embolization only in a prospective multicenter registry from August 2011 to December 2021, and ultimately included 92 AVMs who had achieved angiographic obliteration. Recurrence was assessed by follow-up digital subtraction angiography (DSA) or magnetic resonance imaging (MRI). Hazard ratios (HRs) with 95% confidence intervals were calculated using Cox proportional hazards regression models. Nineteen AVMs exhibited recurrence on follow-up imaging. The recurrence rates after complete obliteration at 6 months, 1 year, and 2 years were 4.35%, 9.78%, and 13.0%, respectively. Multivariate Cox regression analysis identified diffuse nidus (HR 3.208, 95% CI 1.030-9.997, p=0.044) as an independent risk factor for recurrence. Kaplan-Meier analysis confirmed a higher cumulative risk of recurrence with diffuse nidus (log-rank, p=0.016). Further, in the exploratory analysis of the effect of embolization timing after AVM rupture on recurrence after the complete obliteration, embolization within 7 days of the hemorrhage was found as an independent risk factor (HR 4.797, 95% CI 1.379-16.689, p=0.014). Kaplan-Meier analysis confirmed that embolization within 7 days of the hemorrhage was associated with a higher cumulative risk of recurrence in ruptured AVMs (log-rank, p<0.0001). This study highlights the significance of diffuse nidus as an independent risk factor for recurrence after complete embolization of AVMs. In addition, we identified a potential recurrent risk associated with early embolization in ruptured AVMs.
摘要：
很少报道栓塞后动静脉畸形（AVM）复发。本研究旨在探讨血管内栓塞治疗血管造影消失的AVM复发的潜在危险因素。这项研究回顾了2011年8月至2021年12月仅在前瞻性多中心注册中进行栓塞治疗的AVM，最终包括92例血管造影闭塞的AVM。通过随访数字减影血管造影（DSA）或磁共振成像（MRI）评估复发。使用Cox比例风险回归模型计算具有95％置信区间的风险比（HR）。19例AVM在随访影像学上显示复发。6个月时完全闭塞后的复发率，1年,两年为4.35%，9.78%,和13.0%，分别。多因素Cox回归分析确定弥漫性病灶(HR3.208,95%CI1.030-9.997,p=0.044)为复发的独立危险因素。Kaplan-Meier分析证实弥漫性病灶复发的累积风险较高(log-rank,p=0.016)。Further,在AVM破裂后栓塞时机对完全闭塞后复发的影响的探索性分析中，发现出血7天内的栓塞是独立的危险因素（HR4.797，95％CI1.379-16.689，p=0.014）。Kaplan-Meier分析证实，出血后7天内栓塞与破裂AVM复发的累积风险较高相关（log-rank，p<0.0001)。这项研究强调了弥漫性病灶作为AVM完全栓塞后复发的独立危险因素的意义。我们确定了与破裂AVM早期栓塞相关的潜在复发风险.
