Facial Arteriovenous Malformation Embolized Using n-Butyl-2 Cyanoacrylate and Contrast Stasis Rather Than Tantalum Powder with Double Flow Arrest to Prevent Skin Discoloration: A Technical Note

Abstract

Arteriovenous malformations (AVMs) are congenital errors of vascular morphogenesis that occur during development of the cardiovascular system. Multiple treatment options exist, including coil embolization, Onyx embolization, n-butyl-2 cyanoacrylate, alcohol embolization or sclerotherapy, and open surgical treatments. When the AVM involves superficial regions of the face, head, and neck, it is important to consider cosmetic side effects, such as surgical scarring and skin discoloration. A 23-year-old woman presented with a large, anterior mandibulofacial AVM first identified on computed tomography angiography and confirmed with digital subtraction angiography. The lesion was subsequently embolized using n-butyl-2 cyanoacrylate and contrast stasis for visualization during the procedure, instead of traditional tantalum powder. Flow arrest accompanied by contrast stasis allowed changes in density observed using digital subtraction software, thus avoiding the use of material that might be cosmetically disfiguring. This technique for treatment of superficial AVMs avoids the use of materials that may be seen through or discolor the skin and other soft tissue.