Absolute Ethanol Embolization of Infiltrating-diffuse Extracranial Arteriovenous Malformations in the Head and Neck

Extracranial arteriovenous malformations (AVMs) of an infiltrative type in the head and neck can cause cosmetic, functional, and psychological problems. This study reports a single center experience and evaluates the clinical safety and effectiveness of the sole use of absolute ethanol embolotherapy for infiltrative extracranial AVMs in the head and neck.

From June 2011 to June 2013, 168 consecutive patients with extracranial AVMs in the head and neck underwent staged ethanol or other methods of embolization, of whom 66 patients had infiltrating-diffuse extracranial AVMs of type III in the head and neck. Absolute ethanol embolization was solely used and retrospectively evaluated. All patients were assessed at clinical follow up (mean 16.8 months; range 12-38 months). Therapeutic outcomes were determined by evaluating the clinical outcome of symptoms and signs, as well as the degree of devascularization by follow up angiography.

For the 96 sessions, the mean amount of ethanol used in a single embolization session was 13.6 mL and range was from 2 to 25 mL. Fifty-six of the 66 patients were effectively controlled with 100% of the AVMs devascularized, and the remaining 10 patients had partial remission with various degrees of AVM devascularization (50-99%). Transient hemoglobinuria occurred in five of the 66 patients for a total 16 out of 96 procedures. There were no major complications.

The sole use of ethanol embolotherapy appears to be efficacious and safe in the management of infiltrating-diffuse extracranial AVMs in the head and neck.