Mandibular AV Malformation: Life-Threatening Bleeding from the Mouth managed by Endovascular Intervention Complicated by Acute Ischemic Stroke on table. Case Report

Mohammed Habib,Mohanned Alhadad,Khaled Alkhodari,Mohammed Hillis,Aghayed Almobayed

doi:10.31579/2692-9759/041

Abstract

Arteriovenous malformations (AVM) of mandibula are rare abnormal congenital vascular condition that can result in serious complications. Although, various treatment options have been advocated in the literature, there seems to be no complete consensus on a suitable treatment option in these cases. Here, we describe a case of mandibular AVM, who has presented with massive oral bleeding, treated successfully by embolization of the bilateral external carotid arteries and the left superior thyroid artery. During the procedure, the patient developed symptoms of acute ischemic stroke that was diagnosed and managed during the same session by endovascular techniques.

Highlights

Mandibular arteriovenous malformations (AVMs) are very rare congenital vascular anomalies
While treatment is unneeded for small and asymptomatic mandibular AVMs, the symptomatic AVMs should be treated with surgery, embolization, or both (3)
We present a case with recurrent spontaneous bleedings due to a large mandibular AVM refractory to surgical ligation of left proximal external carotid artery four years ago

Summary

Introduction

Mandibular arteriovenous malformations (AVMs) are very rare congenital vascular anomalies. A 27-year-old male dentist who has a huge mandibular AVM for the last five years During this period, the patient had his first bleeding four years ago that was managed by the left external carotid artery ligation. The patient had his first bleeding four years ago that was managed by the left external carotid artery ligation After that, he had a CT angiography that showed a huge left mandibular AVM. The patient was advised to totally control the AVM by endovascular intervention, yet he did not seek advanced management for his case This time, the patient has presented to the emergency room of Al-Shifa Hospital (Gaza, Palestine) due to a sudden massive mouth bleeding. The patient developed right side hemiplegia and he was diagnosed with acute ischemic stroke; mechanical thrombectomy in the same session was done to remove small thrombus from left middle cerebral artery and complete reversal of symptoms was noted

Findings

Discussion

Conclusion