Superselective embolization and surgery of noninvoluting hemangiomas and A-V malformations

Eight patients with severe arteriovenous malformations of the head and neck region have been treated by superselective embolization utilizing Ivalon and surgery. Six of those patients underwent surgical resection of the malformation following embolization with apparent lack of recurrence of the vascular tumor. The approach of superselective embolization is different because it is an attempt to occlude the malformation from the inside out, that is, occluding the smallest vessels first, and utilizes the increased vascular demand of the tumor. The increased blood flow to the malformation is seen to change, since new vessels dilate instantly following occlusion of major feeders. The malformations fill from the ipsilateral side first, but frequently from the contralateral vessels as well. The futility of surgical ligation of large incoming filling vessels is pointed out. Complications other than what may occur with any transfemoral arteriogram included skin slough, particularly when the "glue" was utilized to an excess of extracranial sites.