The safety and effectiveness of ethanol embolosclerotherapy in the treatment of arterio-venous malformations: a systematic review and meta-analysis.

Abstract

This systematic review and meta-analysis evaluates the safety and effectiveness of ethanol embolosclerotherapy for musculoskeletal and soft tissue arteriovenous malformations. Thirty-three studies comprising 920 patients were included. Symptom resolution or improvement was achieved in 96% (95% CI: 92-98%) of patients after multiple treatments and in 25% (95% CI: 16-37%) following a single treatment. Outcomes were more favourable in younger patients (SMD = 0.35, 95% CI: 0.02-0.68, p = 0.04) and varied by anatomical site, with lower success rates in hand/foot lesions. Major adverse events occurred in 2% (95% CI: 1-3%) of treatments. Clinical (Schöbinger type II vs III lesions) and angiographic (Cho-Do type II vs III lesions) classifications did not significantly predict outcomes. These findings support ethanol embolosclerotherapy as an effective treatment for arteriovenous malformations, particularly in younger patients. KEY POINTS: Question What is the overall effectiveness and safety of ethanol embolosclerotherapy in treating high-flow arteriovenous malformations? Findings Ethanol embolosclerotherapy improved or resolved symptoms in 96% of patients, with major adverse events occurring in only 2% of treatments. Clinical relevance The results provide strong evidence for the continued use of ethanol embolosclerotherapy in the treatment of arteriovenous malformations and support earlier intervention when possible. This review offers clinicians a summary reference of treatment practices used across multiple centres.