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

Abstract

Background and purposeArteriovenous malformations (AVMs) derived ophthalmic artery (OphA) branches are not common, however, their management is very challenging. We aimed at evaluating the safety and efficacy of Trans OphA ethanol embolotherapy for these lesions.Materials and methodsWe retrospectively reviewed 26 patients with AVMs fed by OphA, who underwent transOphA embolization using ethanol from February, 2015 to December, 2019. Sixty-six transOphA embolotherapy procedures (range, 1-4 procedures; mean, 2.5 procedures) were performed. Degree of devascularization, visual field, visual acuity, and quality-of-life outcomes were compared and analyzed at follow ups (mean, 32.6 months; month range 10-60). Complications were recorded.ResultsTwenty of the 26 patients (77%) reported complete or >90% AVM devascularization while six patients (23%) showed >70% devascularization. Eleven patients (42%) presented with visual acuity impairments with 4 complete relief, 6 improvements. Eight patients (42%) presented visual field defects with 4 complete relief, 3 with improvements. Ten patients (38.4%) presented with diplopia and exophthalmos with 2 complete relief, 6 major improvements. Bleeding was controlled in all cases (100%). All patients (100%) exhibited cosmetic deformities with 17 being completely relieved. Moreover, all patients (100%) exhibited impaired daily life, which was resolved in 21 patients with 5 patients reporting major improvements. No vision loss, death, or permanent disability in all patients.ConclusionsTransOphA ethanol embolotherapy was found to be efficacious, safe and it achieved symptomatic resolution or improvement of AVMs fed by OphA with acceptable complications without the risk of visual impairment.