Trans-ophthalmic arterial ethanol embolotherapy for arteriovenous malformations: a single-center experience

Arteriovenous malformation (AVM)-derived ophthalmic artery (OphA) branches are not common, and their management is very challenging. We evaluated the safety and efficacy of Trans OphA ethanol embolotherapy for these lesions. We retrospectively reviewed 26 patients with AVMs fed by OphA, who underwent transOphA embolization using ethanol from February, 2015 to December, 2019. Sixty-six transOphA embolotherapy procedures (range, 1-4 procedures; mean, 2.5 procedures) were performed. Devascularization degree, visual field, visual acuity, and quality-of-life outcomes were compared and analyzed at follow up (mean, 32.6 months; month range 10-60). Complications were recorded. Twenty-five of the 26 patients (96%) reported complete or > 90% AVM devascularization while one patient (4%) showed > 70% devascularization. Eleven patients (42%) presented with visual acuity impairments; among them, 6 had improvements while 4 were completely relieved. Eight patients (30.7%) presented visual field defects, 3 had improvements while 4 were completely relieved. Ten patients (38.4%) presented with diplopia and exophthalmos with 2 being completely relieved while 6 had major improvements. Bleeding was controlled in all cases (100%). All patients (100%) exhibited cosmetic deformities with 17 being completely relieved. Moreover, all patients (100%) exhibited impaired daily life, which was resolved in 21 patients with 5 patients reporting major improvements. After endovascular treatment, there was no vision loss, death, or permanent disability in any patient. TransOphA ethanol embolotherapy is efficacious and safe for symptomatic resolution or improvement of AVMs fed by OphA with acceptable complications without the risk of visual impairment.