Embolization for Arteriovenous Malformations in the Maxilla With Coils and Ethanol

Abstract

Maxillary arteriovenous malformations (AVMs) are uncommon, limiting comprehensive research into standard treatment protocols. This study evaluated the management, outcomes, and clinical safety of embolization techniques for maxillary AVMs, using coils and ethanol. In this retrospective case series, we enrolled a sample of patients with maxillary AVMs treated with embolization using coils with or without ethanol between June 2017 and July 2019. Coils were super-selectively placed into the nidus and dominant outflow vein to decrease the flow of the arteriovenous fistulas. Absolute ethanol was then injected to obliterate the nidus. Clinical follow-up was performed for all the patients, and therapeutic outcomes were measured by evaluating the degree of devascularization and symptoms. Ten patients were included in the present study, including 4 men (40%) and 6 women (60%), with a mean age of 18.1years (range, 10 to 36years). Transvenous release of coils (9 detachable coils and 143 pushable coils), either with or without absolute ethanol embolization, was used in all the patients. The amount of ethanol injected ranged from 0 to 12mL (mean: 6.5mL; 95% confidence interval: 3.489 to 9.511) in a single session. Seven (70%) of the 10 patients were cured, while 3 patients (30%) had partial remission. Follow-up times ranged from 26 to 42months (median: 29.7months). Tooth loosening and coil exposure occurred in 7 patients (70%) and healed after surgery. No major complications were noted. Coils and ethanol embolization have the potential to cure AVMs in the maxilla with an acceptable risk of minor complications.