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S184 PYA particles in addition to cyanoacrylate. Follow-up was completed in all patients (mean, 3.7 years; range 0.2 to 13). Three patients with upper limb HFAVM had a good clinical response to embolization and remained symptom free for more than two years post procedure; one patient had no clinical response to treatment. In the lower limb HFAVM group, one patient experienced resolution of symptoms (> 2 years symptoms free) ; the remaining seven had partial responses with partial relapse within a few months « 6 months) post treatment. Two major complications were recorded (8.7% per session or 16. 7% per patient); one patient with intraosseous involvement of tibia developed tibial plateau compression fracture 4 weeks post embolization and one patient had temporary sensory loss ofL5 dermatome following pelvis and thigh embolization. CONCLUSION: Peripheral HFAVM is a rare but highly challenging condition that requires intensive multidisciplinary approach. Cyanoacrylate as an embolic agent is effective in the management of upper limb lesions but not as efficacious for lower limb lesions. This is most likely related to the disease process rather than the embolic agent. 5:47PM Abstract No. 116 Peripheral High Flow Arteriovenous Vascular Malformations: A Review of 31 Patients. KT. Tan, Medical Imaging, University Health Network, Toronto, ON, Canada·ME. Simons'D.K RajawK Terbrugge PURPOSE: To assess the long-term outcome of patients with extremity high-flow arteriovenous malformation (HFAVM). MATERIALS AND METHODS: A retrospective review was performed to identify patients with HFAVM referred for possible intervention between 1990 and 2003. Sixteen patients with upper limb and 15 patients with lower limb HFAVM were identified (mean age 36.8 years, range 21.1 to 72.2). Embolizations were performed via transfemoral (n= II), transbrachial (n=2) and direct puncture of nidus (n= I) . Cyanoacrylate and PYA were used in 12 and 2 patients respectively. RESULTS: FolJow-up was completed in 30 patients (mean, 3.3 years; range, 0.2 to 13) with one patient lost to follow-up. Twenty patients had symptoms that warranted endovascular treatment; 14 underwent embolotherapy, and 6 were considered unsuitable because of challenging anatomy that rendered embolization unsafe. Eleven patients' symptoms did not warrant treatment and were treated conservatively. The 14 patients who had embolotherapy received a total of 26 treatment sessions (mean, 1.9 sessions per patient; range, I to 5). Seven patients had resolution of symptoms and the HFAVM angiographically post treatment and 5 patients' symptoms were controlled despite persistence of the HFAVM angiographically. Two patients had no improvement post treatment. Two major complications occurred (7.7% per session or 14.3% per patient); one case of tibial plateau fracture and a case oftemporary L5 dermatome sensory loss following pelvis and thigh embolization. Of the 6 patients who were considered unsuitable for embolotherapy, one patient underwent successful surgical excision, one patient died of hepatoma and the remaining 4 patients' symptomatology were unchanged and continued with conservative management. No patients who were treated conservatively developed progression of symptoms or required invasive therapy during follow-up. CONCLUSION: Patients with peripheral HFAVM and have minimal symptoms at presentation do well with conservative treatment with minimal symptomatic progression in this series. Only patients with significant symptomatology should undergo embolization therapy, which invariably requires multiple treatments. Scientific Session 22 Late Breaking Abstracts Saturday, March 27, 2004 4:30 PM - 6:00 PM Scientific Session 23 Carotid Interventions Saturday, March 27, 2004 4:30 PM - 6:00 PM Moderator(s): George Teitelbaum, MD Joan WOjak , MD 4:30PM FEATURED AB5iTRACT Abstract No. 117 Commentator: John .1. "Buddy" Connors III. I\ID Outcomes of Unprot ec t ed &, Protected C arotid S tenting (EmboSbield n, ): RandomiZed Trial. S. Macdonald, Sheffield Va cularinstitute, Sheffield, Yorkshire, England·T.J. Cleveland·PA. Gaines'P Grif.ftth:i'l. Graham·F. McKevitt, el al. !PU RPOSE: To use a sensitive means of assessing subtl neurological injury when comparing protected and unprotected carotid ste nting to allow an adequat e ly p wered small randomized lriaL MA TERIALS AND METHOD S: 30 patients wi tH symptomatic atherosclerotic carotid artery stenosis .2! 70% (NA. 1') were randomized between the two treatment limbs. The groups were comparable fOT age, sex, lndicati on fOIl treatment and lesion characteristics. An ex len ive battery oE 21 tests representing each cognitive domain including executive function was applied pre-slenting and al30-days post-stenting by an experienced neuropsychologist. Measures f depression. dementia and global function ART lQ) were included. The battery was chosen for its sensitivity to unpredictable neuronal injury, subtle or overt to include focal, multi fo cal and ditTuse 'lesions. ParaHel tests Were utilized where possible to minimize practice effects. The raw cores were compared with age adjusted means from large sample popu l ations and an Jl deviati on from baseline quantified. For eacb patient post- procedure perf Oimance was compared with baseline. etween-groups parameters evaluated were: 1. Any deteriorati on and 2 standard d ev iati ons) , !2. SDs 3. Any improv ment I and 2 standard deviations), 4. Improvement;::: 2 SDs : erfomlances were compared using the Chi Square or Fisher 's exac!tests,if the a&sumptions were violated.
