Midterm and long-term results of ethanol embolization of auricular arteriovenous malformations as first-line therapy

The objective of this study was to assess the midterm and long-term results of patients with auricular arteriovenous malformations (AVMs) treated by ethanol embolization.

Medical records of 35 patients (20 male, 15 female; age range, 10-59 years) with auricular AVMs between 2006 and 2016 were reviewed. The short-term results of 4 of the 35 patients were reported in 2009. They were included in this study with updated follow-up data. The data from the 31 new included patients have not been reported previously. Ethanol embolization was performed with a direct puncture approach. The nidus was eradicated by bolus injection of ethanol with manual compression whenever possible. Treatment outcomes were classified into four categories by assessing the resolution of symptoms as well as the degree of nidus devascularization between the baseline and follow-up angiography studies.

A total of 86 embolization sessions were performed in 35 patients (mean, 2.5 ± 1.3 sessions). The dosage of ethanol used per single session was 12.0 ± 4.5 mL (range, 6.0-24 mL). All patients received post-treatment clinical follow-up (mean, 40.7 ± 25.8 months), and 28 patients received post-treatment imaging follow-up (mean, 34.3 ± 25.5 months). Ethanol embolotherapy was effective in all patients. Control was achieved in 16 patients (45.7%), and improvement was achieved in 18 patients (51.4%). One patient experienced recurrence. A total of 13 minor complications and 2 major complications occurred in 12 patients during the 86 treatment sessions (12/35 [34.2%]; 15/86 [17.4%]). All the complications resolved spontaneously.

The midterm and long-term results of this study demonstrate that ethanol embolization alone is an effective option for auricular AVMs as first-line therapy with a mild risk of minor and major complications.