Management of extracranial arteriovenous malformations of the head and neck

Abstract

The purpose of this study was to review the outcomes of the different therapies for extracranial head and neck arteriovenous malformations (AVMs).AVMs are high-flow congenital vascular anomalies. They are composed of a complex system of vessels directly connecting feeding arteries to draining veins forming a nidus.They may be potentially life-threatening due to progressive symptoms and infiltrative disease. Extracranial AVMs most commonly affect the head and neck area (47.4%) followed by the extremities (28.5%). AVMs are best characterized as being either focal or diffuse. Focal AVMs have good outcomes following adequate treatment. Diffuse lesions have multiple feeding vessel, which results in high rates of recurrence despite treatment.The management of AVMs includes conventional surgery and endovascular techniques. A combination of embolization and surgical resection has become the treatment of choice over the last years. The main goal of both forms of treatment being the complete blockage or resection of the nidus. Transcatheter embolization of vessels has evolved over the years and new embolic agents have emerged. The types of materials available for embolization are classified into mechanical devices, liquid agents and particulates. Efficacy, rate of recurrence and most common complications were evaluated.AVMs recurrence after embolization or resection is reported in up to 80% of cases. Incomplete resection and embolization can induce aggressive growth of the remaining nidus and the risk of progression is up to 50% within the first 5 years and recurrences can occur up to 10 years later.✩ This article was written by members and invitees of the International Head and Neck Scientific Group ( www.IHNSG.com).

Trans-ophthalmic Arterial Ethanol Embolotherapy for Arteriovenous Malformations: A Single Centre Experience

“…The most common complications reported skin necrosis owing to over injection and re ux of ethanol 4,9 , especially in the periorbital skin. Park et al reported that intra-arterial ethanol injection causes skin necrosis because tiny, angiographically invisible normal arteries become exposed to ethanol.…”

The role of combined computed tomographic angiography and digital subtraction angiography in the management of cervico-facial vascular lesions

“…A combination of embolization and surgical resection has become recently the treatment of choice. The main goal of both is the complete devascularization of the vascular lesion [6].…”

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“…Embolic agents can be classified according to their chemical ingredients into liquid such as histoacryl, and particulates like polyvinyl alcohol (PVA), as well as coils. Also, they can be classified into temporary and permanent embolic agents according to their duration effect [6].…”

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