Endovascular management of auricular arteriovenous malformations

Abstract

This is a retrospective review of eight patients with extracranial arteriovenous malformations (AVMs) of the auricular region. All cases presented with significant hemorrhages or cosmetic defects. Highflow AVMs of the auricular are quite rare in contrast to low flow vascular lesions of the head and neck, making early diagnosis and treatment critical as incidences of recurrence are high if not managed properly. The purpose of this study is to present our experience of experimental endovascular treatment in a series of eight patients with auricular AVMs. From January 2015 to December 2017, eight patients with auricular AVM were put through transcatheter arterial embolization and percutaneous direct puncture embolization with polyvinyl alcohol (PVA) and bleomycin in five patients, glue embolization in one patient and coiling along with PVA in two patients to occlude high-flow fistula. Clinical outcomes were obtained through physical examination, and symptoms and a degree of devascularization on follow-up angiography. We performed 10 therapeutic embolization procedures. Of these, 3 resulted in absolute devascularization while 5 resulted in 75% obstruction. In 5 patient's embolization was performed as a palliative procedure. The other 3 were embolized as a sole mean of treatment for occluding the AVM. Only two patients developed postembolization necrosis and infection, and there has been no reexpansion of lesions to date. While thus far only having been used as percutaneous local sclerotherapy, this study found that bleomycin and PVA mixture, if used intraarterially can be more effective in the management of auricular AVM's.