Retrograde transvenous balloon-assisted Onyx embolization of mandibular arteriovenous malformation after hemorrhage

Abstract

Mandibular arteriovenous malformation (AVM) is a rare lesion, but it often can be presented with life-threatening bleedings. Endovascular treatment of mandibular AVMs has multiple approaches including transarterial embolization, transvenous embolization, direct puncture, and sclerotherapy. In this case study, we present a patient with mandibular AVM complicated by hemorrhage. The patient was treated with transarterial embolization, followed by transvenous sclerotherapy with balloon occlusion of venous outflow. But radical occlusion of AVM was achieved only by transvenous embolization of AVM with Onyx via double lumen balloon, which occluded the venous outflow.

Endovascular embolisation of a complex mandibular AVM: a hybrid transarterial and transvenous approach

“…The various endovascular treatment approaches of these lesions include pure transarterial embolisation, transvenous embolisation, percutaneous embolisation and or a combination of these techniques 3 10 11. Onyx is the preferred agent of choice and should be considered first line in the treatment of these lesions.…”

“…The high-flow AVMs are usually associated with a nidus followed by direct arteriovenous shunting 1. Maxillofacial AVMs contribute to 50% of overall body AVMs, with an incidence of approximately 1 in 50 000 2 3. They can be associated with fistulous communications between the branches of external carotid artery (ECA) and mandibular veins 4…”

“…Clinically they can present with tooth pain, loosening of teeth, swelling, bruit and symptoms of bleeding ranging from mild ooze to life-threatening haemorrhage 5 6. Cross-sectional imaging with CT/ MRI angiography is essential to establish the diagnosis, to locate the extent and soft tissue/bony involvement of the lesion 3…”