Arteriovenous malformation management

Abstract

Arteriovenous malformations (AVM) are rare vascular lesions that can present with a myriad of clinical presentations. In our institutions, initial workup consists of a clinical exam, color Doppler imaging, and magnetic resonance imaging. After the initial noninvasive workup, arteriography, at times closed system venography, and ethanol endovascular repair of the AVM is performed under general anesthesia. Depending on the size of the lesion, additional Swan-Ganz line and arterial line monitoring are performed. Patients are usually observed overnight and uneventfully discharged the following day if no complication occurs. Patients are followed at periodic intervals despite cure of their lesion. Long-term follow-up is essential in AVM management.

Ethanol Embolization of Arteriovenous Malformations of the Mandible

“…Once this mechanism occurs, the endothelial cell is re-endothelialized and recanalization occurs. 9 With the use of absolute ethanol, the endothelial cell is denuded from the vascular wall, its protoplasm is precipitated, and there is a fracture in the vascular wall to the level of the internal elastic lamina. In AVMs, these changes are desirable and account for the curative effects and permanence of ethanol embolization.…”

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

“…4,15 The central and significant feature of an AVM is the presence of a primitive vascular nidus that rapidly empties into dilated tortuous outflow veins without the presence of a normal capillary bed. 5 In AVMs, the endothelial cells demonstrate a normal rate of cellular division and do not regress at the histologic level. 3,15,16 The external ear is the second most common site for extracranial AVMs in the head and neck.…”

“…However, when ligation of the proximal feeding arteries or partial resection is performed, with time, recurrent symptoms equal to or worse than the patient's primary problem can be observed because the remaining abnormal vascular elements become very aggressive. [3][4][5]14,17 Although a "total resection" is achieved, a 5-year follow-up is necessary before reconstruction is performed to make certain there is no evidence of recurrence. 1 With improved catheter technology, superselective techniques, and improved embolic agents, embolotherapy now plays a significant role in the treatment of AVMs.…”

“…The total amount of absolute ethanol used per session was less than 1 mL/kg of body weight. 4,5 Postoperative management consisted of dexamethasone and intravenous infusion of fluids. Patients with gastrointestinal tract sensitivity to steroids could also be given ranitidine to protect against the development of a gastric or duodenal ulcer.…”

“…Because of the relatively rare and extremely varied clinical presentations, which can range from an asymptomatic birthmark to a life-threatening condition, it is difficult to develop sufficient experience for a learning curve of diagnosis and optimal treatment of the lesions. [1][2][3][4][5] At present, it is widely accepted that, for symptomatic auricular AVMs, complete excision with previous embolization is the treatment of choice. [1][2][3][6][7][8][9] Total amputation, which requires a wide-field resection of all of the involved tissue, is necessary to prevent recurrence, but the cosmetic and functional issues might limit the extent to which tissue can be removed.…”