Arterio venous malformation of the face: surgical treatment

Sclerotherapy for the management of venous malformations: Experience from a single institution in Afghanistan

Sclerotherapy is a convenient modality for the treatment of venous malformation. Ethanol as a sclerosing agent is easily available and cheap. Sclerotherapy for venous malformations has both functional as well as aesthetic outcome.

Super-selective and staged glue embolization for labral AVMs using ultra-thin microcatheters: report of two cases

BACKGROUND

Treating arteriovenous malformation (AVM) is challenging because of the high recurrence rate and because incomplete resection or embolization can induce aggressive growth. However, a standard strategy is not fully established. Although transcatheter arterial embolization (TAE) is currently almost always part of the treatment, in many cases, single treatment is not curative and only palliative. Additionally, the success and complication rates associated with TAE alone are unclear, and there has been limited study of staged TAE for facial AVMs. Furthermore, few reports have described the details of the procedure.

CASE-PRESENTATION

We report two cases of AVM of the upper lip in patients who were successfully treated by staged super-selective TAE at several-month intervals using ultra-thin microcatheters and n-butyl-2-cyanoacrylate.

CONCLUSION

Staged and super-selective TAE may prevent complications and provide high curability and might be a useful treatment in cases of AVM.

Exclusive surgical approach for facial arteriovenous malformations in precarious conditions

Arteriovenous malformations (AVMs) are high-flow vascular lesions that does not regress spontaneously. They are located in the cranio-facial region in 50% of cases. Most of the time, the management of these lesions is a combination of surgery and vascular embolization. However, when the conditions are precarious, even without access to embolization, it's possible to treat some of those lesions with safety. We report four cases of patients suffering from cranio-facial AVM, treated exclusively by surgery during humanitarian missions.

Giant arteriovenous malformation of the face and upper lip

A 35-year-old male patient reported with the chief complaint of a large swelling in the right side of the upper lip. The lesion measured 6.5 cm measuring from the infraorbital region to the lower border of mandible on the right side of the face and 7.5 cm from the right ear lobule to the contralateral commissure of the left side of the face. On palpation, the swelling was soft, fluctuant and compressible. Pulsations were felt, and on auscultation, bruit was also heard. Computed tomography angiogram of the neck and circle of Willis showed serpiginous hyperdense vascular channels causing significant soft-tissue thickening of the upper lip, right cheek region and philtrum. Hence, the diagnosis of diffuse subcutaneous facial arteriovenous malformation involving the right cheek and philtrum was given. The entire lesion was excised. In the postoperative 2^nd month, secondary cosmetic correction or lip reconstruction was done. The patient was reviewed after 3 years; there was no recurrence of the lesion.

Role of Interventional Radiology in the Management of Peripheral Vascular Malformations: A Tertiary Care Center Experience

Peripheral vascular malformations (PVMs) represent a wide spectrum of vascular abnormalities occurring due to anomalous connections between arteries, veins, capillaries, and lymphatic channels at the microscopic level, in different combinations. They are rare and challenging to treat. Different operators may have different approaches based on their experience and expertise. Sclerotherapy either alone or in combination with embolization has been used as an independent method for the treatment of PVMs.

Purpose

The aim of this study is to assess the safety and efficacy of sclerotherapy and embolization, with or without surgery, for the treatment of peripheral vascular malformations, based on our approach.

Materials and methods

A retrospective review of all patients with PVMs treated in our interventional radiology department from 2011 to 2017 was carried out. Medical records, imaging, and follow-up notes were reviewed to evaluate the response to treatment and post-procedure complications.

Results

Thirty-four sessions were performed in 15 patients (eight male, seven female) with PVMs. Low-flow lesions were identified in 10, intermediate flow in one, and high flow in four patients. Sodium tetradecyl sulfate (STS) was used as the sclerotherapeutic agent in 10 (66.67%), glue with lipoidal in three (20.0%), and bleomycin in one patient (6.67%). Coils with PVA and a covered stent were used in one and a combination of coil, PVA, and gel foam was used in one patient. A marked response was seen in 11 and a partial response in four patients. One patient developed foot gangrene. Stent thrombosis was noted in one patient with no clinical consequences. Recurrence was seen in two patients, who were lost to follow up.

Conclusion

PVMs are complex lesions. Sclerotherapy with or without embolization is a safe and effective treatment modality, with clinical response approaching 100%.

Arterio-Venous Malformations of the Nose: Combined Approach for a Successful Strategy

BACKGROUND AND PURPOSE

The purpose of the present study is to evaluate the vascular malformations of the head and neck. They are uncommon lesions, but some areas have a significant potential for fatality, due to their massive bleeding. The vascular anatomy of the nose carries a high recurrence rate, due to the unique characteristic of the nose, especially if deep vascular connection is present.

METHODS

The present article describes 2 patients of nasal dorsum arteriovenous malformations, both using a combined procedure: preoperative selective embolization, en-bloc tumor resection, and reconstruction with a forehead flap. Two female patients with arterio-venous malformations of the nose were examined, subjected to excision procedure and forehead flap reconstruction. Current treatment requires surgical resection of the nose and in conjunction with adjunctive endovascular embolization; it reduces arterio-venous malformations recurrence.

RESULTS

The authors report an endovascular and surgical technique to treat nasal arterio-venous malformations, which permits a complete resection and a reconstruction with a forehead flap. There were no major complications such as recurrent ulceration, infection, postoperative bleeding, or flap failure. All the patients responded positively and satisfactory results were achieved in both female patients.

CONCLUSIONS

To reduce the recurrence of arterio-venous malformations, the multidisciplinary therapy is mandatory. Recent advances in microsurgery and interventional radiology have greatly improved prognosis for patients with arterio-venous malformations. Therefore, a preoperative selective embolization followed by surgical excision seems to be a good compromise for arterio-venous malformations therapy. The forehead flap, for its characteristics, represents the better choice for nasal reconstruction.

Treatment of Residual Facial Arteriovenous Malformations after Embolization with Percutaneous Cryotherapy

This report presents 4 patients (mean age, 22 y; range, 17-26 y) with facial arteriovenous malformations (AVMs) who underwent arterial ethanol and N-butyl cyanoacrylate embolization followed by percutaneous cryoablation of residual inaccessible AVMs. After the procedure, minor complications classified as type B according to the Society of Interventional Radiology (SIR) classification system occurred in 75% (3/4) of patients. One patient achieved 90% obliteration of AVM, and 3 patients had complete obliteration of AVM at 1-year follow-up. This reports shows that percutaneous ablation may be a viable treatment option for residual facial AVMs after ethanol and glue embolization.