Management of Complex Arteriovenous Malformations Using a Novel Combination Therapeutic Algorithm.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Pharmacology

Background:

• Extracranial head and neck arteriovenous malformations (AVMs) present limited therapeutic options.
• Conventional treatments like sclerotherapy and resection often lead to disease recurrence and progression.
• There is a need for effective adjuvant therapies to improve outcomes for complex AVMs.

Observation:

• A case series of 6 patients with complex extracranial head and neck AVMs was analyzed.
• Patients received sirolimus (a mammalian target of rapamycin inhibitor) prior to and following endovascular embolization.
• Treatment efficacy and tolerability were assessed through clinical evaluation and radiographic imaging.

Findings:

• All 6 patients demonstrated a favorable response to the combination therapy, with 4 achieving a near-complete response.
• The treatment regimen was generally well-tolerated, with mild adverse effects reported in 4 patients.
• One patient experienced AVM regrowth after discontinuing sirolimus, which stabilized upon re-initiation.

Implications:

• Sirolimus may serve as a beneficial adjuvant therapy for endovascular embolization in managing complex head and neck AVMs.
• Further prospective trials are warranted to confirm these findings and determine optimal sirolimus dosing and duration.
• This approach could offer improved management strategies for challenging AVM cases.