Direct percutaneous puncture digital-subtraction-angiography-based classification and treatment selection for soft-tissue arteriovenous malformations of maxillofacial region: a retrospective study

Abstract

Treatment of arteriovenous malformations (AVMs) should be individualized based on the imaging findings. A total of 117 AVM cases were categorized into three types based on the angio-architectural characteristics: Type I (n=14, no draining vein or diameter of the draining vein <2mm); Type II (n=64, draining vein diameter 2–6mm); and Type III (n=39, draining vein diameter >6mm). Subjects were randomly allocated to one of two treatment groups: Group A (n=59) received multipoint percutaneous ethanol injection (MPEI), while Group B (n=58) received super-selective angiograms followed by embolization with gelfoam (EFAG) plus MPEI. Patients were followed up for 2–6 years. A significant between-group difference with respect to treatment outcomes was observed only for Type III cases (P<0.05). Direct percutaneous puncture digital-subtraction-angiography-guided classification of AVMs provides easy-to-follow guidelines for its clinical management. EFAG plus MPEI with reduced procedure time and the amount of ethanol should be used for Type III AVMs.