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Shen Y, Han Q, Wang D, Su L, Wen M, Fan X, Yang X. Coil-assisted ethanol embolization of traumatic arteriovenous fistulas: a 10-year retrospective study. Front Cardiovasc Med 2024; 11:1449480. [PMID: 39301499 PMCID: PMC11412004 DOI: 10.3389/fcvm.2024.1449480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 08/20/2024] [Indexed: 09/22/2024] Open
Abstract
Purpose This study aimed to evaluate the efficacy and safety of ethanol embolization in treating traumatic arteriovenous fistulas (TAVFs). Materials and methods From March 2012 to April 2020, 42 consecutive patients (29.9 ± 15.1 years, range: 3-68 years) with peripheral TAVFs underwent ethanol embolization. All patients underwent clinical and imaging follow-ups (40.0 ± 25.9 months, range: 3-90 months). The mean time to onset of symptoms after trauma was 5.4 ± 5.9 months (range: 0.5-30 months). Among the patients, 27 (64.3%) reported that the TAVFs occurred after blunt trauma, 10 (23.8%) presented after penetrating trauma (with 4 patients involving penetration by infusion indwelling needles), and 3 (7.1%) had a history of surgery. Treatment effects, devascularization rates, and complications were evaluated at follow-ups conducted at 1-3 month intervals. Results Seventy-one embolization procedures were performed, with a mean of 1.6 ± 0.7 procedures per patient. Thirty-four patients received coil-assisted ethanol embolization. Absolute ethanol was used in all procedures, with an average volume of 7.1 ± 4.2 ml per procedure (range: 1-18 ml); 28 patients (28/42, 66.7%) received coil embolization in 36 procedures (36/71, 50.7%). Upon re-examination, 39 patients (92.9%) achieved 100% devascularization; of these, 29 patients (74.4%) with Schobinger stage II TAVFs improved to stage I or became asymptomatic. Overall, 30 cases (66.7%) achieved a complete response, while the other 12 cases (33.3%) showed a partial response. In addition, no major complications were observed postoperatively, apart from minor complications. Conclusions Coil-assisted ethanol embolization can effectively manage TAVFs with an acceptable risk of mild complications.
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Affiliation(s)
- Yuchen Shen
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qianyun Han
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Deming Wang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lixin Su
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingzhe Wen
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xindong Fan
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xitao Yang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Asensio JA, Dabestani PJ, Miljkovic SS, Wenzl FA, Kessler JJ, Kalamchi LD, Kotaru TR, Agrawal DK. Traumatic penetrating arteriovenous fistulas: a collective review. Eur J Trauma Emerg Surg 2021; 48:775-789. [PMID: 33386864 DOI: 10.1007/s00068-020-01574-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Traumatic penetrating arteriovenous fistulas (AVFs) are very rare. The majority of these injuries occur secondary to penetrating trauma. Objectives of this study: review their incidence, clinical presentation, radiologic identification, management, complications and outcomes. METHODS A literature search was performed on MEDLINE Complete-Pubmed from 1829-2019. PRISMA guidelines were utilized. Of 305 potentially eligible articles, 201 articles were selected. INCLUSION CRITERIA patients age ≥ 18, articles with title and abstract in English, AVFs secondary to penetrating trauma, articles which specified vessels involved in AVFs, and those reporting complete information on patient presentation, diagnosis, imaging, surgical and/or endovascular surgical management, and outcomes of penetrating AVF's. EXCLUSION CRITERIA articles reporting blunt or iatrogenic AVFs, pediatric patients, fistulas used for dialysis and their complications, articles lacking complete information, cranial/spinal AVFs or cardiac AVFs, and duplicate articles. Mechanism of injury (MOI), diagnosis, involved vessels, management and outcomes of patients with AVFs secondary to penetrating trauma were recorded. RESULTS There were a total of 291 patients with AVFs secondary to penetrating injuries. Mechanism of injury (MOI): stab wounds (SW)-126 (43.3%), Gunshot wounds (GSW)-94 (32.3%), miscellaneous-35 (12%), mechanism unspecified-36 (12.4%). Anatomic area: neck-69 (23.7%) patients, thorax-46 (15.8%), abdomen-87 (30%), upper and lower extremities-89 (30.6%). Most commonly involved vessels-vertebral artery-38 (13%), popliteal vein-32 (11.7%). Angiography was diagnostic-265 patients (91.1%). INTERVENTIONS Surgical- 202 (59.6%), Endovascular-118 (34.8%). Associated: aneurysms/pseudoaneurysms-129 (44.3%). CONCLUSION Most AVFs occur secondary to penetrating injuries. Stab wounds account for the majority of these injuries. Most frequently injured vessels are vertebral artery and superficial femoral vein. Surgical interventions are the most common mode of management followed by endovascular surgical techniques.
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Affiliation(s)
- Juan A Asensio
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA.
| | - Parinaz J Dabestani
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Stephanie S Miljkovic
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Florian A Wenzl
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - John J Kessler
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Louay D Kalamchi
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Tharun R Kotaru
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
| | - Devendra K Agrawal
- Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 7500 Mercy Road, Suite 2871, Omaha, NE, 68124, USA
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Wang C, Ge Y, Li L. Traumatic arteriovenous fistula of the left parotid region: A case report. Oncol Lett 2016; 11:3194-3196. [PMID: 27123088 DOI: 10.3892/ol.2016.4371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 12/02/2015] [Indexed: 02/05/2023] Open
Abstract
The formation of arteriovenous fistula beneath the parotid is relatively rare. To the best of our knowledge, the present study reports the first case of a 48-year-old man with a pulsatile mass on the left parotid region, which had been present for >3 years following penetrating wounds. Computed tomography angiography and digital subtraction angiography revealed a fistula between the left external carotid artery and the left jugular vein. The patient was successfully managed through surgical excision without embolization. Intraoperative facial nerve monitoring was employed to prevent postoperative facial paralysis. The present study briefly reviewed the current literature, illustrating the pathophysiology, symptoms, imaging studies and treatment for arteriovenous fistula in the head and neck region. To conclude, arteriovenous fistula located near the facial nerve may be successfully managed by surgical treatment, without permanent facial paralysis.
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Affiliation(s)
- Chenxing Wang
- Department of Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yaneng Ge
- Department of Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Longjiang Li
- Department of Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Successful treatment of posttraumatic arteriovenous malformation of the lower lip. J Craniofac Surg 2016; 26:e199-201. [PMID: 25974817 DOI: 10.1097/scs.0000000000001282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Arteriovenous malformations (AVMs) are most commonly reported in the brain. Head and neck AVMs are reported to occur in 0.1% of the general population. On the other hand, posttraumatic AVMs are quite rare. Traumatic AVMs are extremely rare in the head and neck and are mostly seen in the extremities. The management of such lesions may include selective embolization or surgical exploration with ligation. A 13-year-old male adolescent visited our hospital for lower lip swelling, which developed 5 years ago after a lower lip laceration. The AVM was expanded and was graded as stage II. It was fed by the mandibular branch of both facial arteries and drained to the posterior facial vein. The radiologic intervention department performed an embolization before the operation. The main operation was performed 12 days after the embolization. A well-demarcated AVM lesion was found in the oral mucosa and was totally excised under general anesthesia. The authors easily performed the operation owing to the embolization making the AVM definitely demarcated and firmly palpable. The lip closure was done carefully considering the lip contour. No sign of recurrence was seen during 6 months of follow-up. The excellent treatment result of the posttraumatic facial AVMs occurs largely because of a collaboration with the radiologic intervention department using the selective embolization.
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Posttraumatic arteriovenous malformation of the face: a case report. J Emerg Med 2013; 46:e5-8. [PMID: 24199729 DOI: 10.1016/j.jemermed.2013.08.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 05/20/2013] [Accepted: 08/15/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Head and neck arteriovenous malformations (AVMs) are reported to occur in 0.1% of the population. Extracranial AVMs account for only 8.1% of head and neck AVMs. Of these, traumatically acquired AVMs of the face are generally reported as quite rare. When secondary to trauma, the lesion is usually supplied by a single vessel, as compared to the multiple vessels often seen with congenital etiology. OBJECTIVES Understanding of regional anatomy is paramount when assessing and managing facial injuries. As an integral health care provider for the facial trauma patient, it is the responsibility of the emergency physician to recognize this rare pathologic lesion necessary to coordinate surgical management of the traumatic AVM. CASE REPORT We present a case report of a patient who sustained a facial laceration complicated by the development of a vascular malformation. The facial laceration in this case report highlights the complexity of wound evaluation and management when treating patients in the emergency department. CONCLUSION Traumatic AVMs are quite rare in the head and neck and are mostly seen in the extremities. Although rare, they have been reported after typical facial trauma as well as elective surgical procedures. The management of such lesions may include selective embolization or surgical exploration with ligation. Emergency physicians and facial trauma surgeons are challenged with recognizing and treating these rare but very real vascular lesions. It is our hope that this case report provides an overview of posttraumatic AVMs in the head and neck.
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