Ethanol Embolization of Auricular Arteriovenous Malformations: Preliminary Results of 17 Cases

Abstract

BACKGROUND AND PURPOSE:Because of the relatively rare and extremely varied clinical presentations, arteriovenous malformations (AVMs) involving the auriculae are technically challenging clinical entities to diagnose and, ultimately, manage. The purpose of our study was to present our initial experience of ethanol embolization in a series of 17 patients with auricular AVMs and assess the interim therapeutic outcomes of this method.

Head and Neck Arteriovenous Malformations: Results of Ethanol Sclerotherapy

“…For example, AVMs with a dilated venous fistula within the mandible or maxilla may respond to several approaches that target the intraosseous venous structure 20,[22][23][24][25][26] ; soft-tissue lesions with diffuse architecture are the most difficult to treat. 21 For the head and neck area, 2 studies on auricular AVMs report success rates for complete nidus devascularization of 18% 18 and 75%. 19 Interpreting these percentages is difficult, because some proportion of the treatments in all series is still ongoing, and the reported material limited.…”

“…Although most complications from ethanol sclerotherapy heal without long-standing functional damage, a serious risk remains for permanent or major complications, reported at 0%-26% frequency per patient. [10][11][12][13][14][15][16][17][18][19][20] Direct interpretation of these figures is difficult because classification of complications between series differs. For example, some include in major complications any event that requires hospitalization for Ͼ48 hours, including those that resolve completely with or without treatment, 14 while others may record as major complications only events that leave a per-manent disturbance.…”

“…29 The most common complication of ethanol sclerotherapy is local skin or mucosal surface necrosis. [10][11][12][13][14][15][16][17][18][19][20] 37 Other possible systemic effects of ethanol include intravascular hemolysis 38 and bronchospasm. 39 Our complication rate was in line with rates in other studies.…”

“…39 Our complication rate was in line with rates in other studies. [10][11][12][13][14][15][16][17][18][19][20] All permanently visible complications included scarring after skin necrosis (n ϭ 5) and local loss of cutaneous hair (n ϭ 2). In retrospect, 3 of our skin/mucosal complications (1 in an upper lip, 1 in a lower eyelid, 1 in a scalp) probably resulted from an injection not sufficiently selective during treatment of a superficial AVM and might have been avoidable.…”

Absolute Ethanol Embolization of Arteriovenous Malformations in the Periorbital Region

“…Encouraged by these results, we began to treat AVMs cases in face and neck with absolute ethanol in 2007. Since then, we have obtained satisfactory results in treatment of AVMs in auricular area and in mandible combined with coils [25].…”