Reconstruction of previously ligated external carotid arteries for cranial base arteriovenous malformation...

Ligation of the external carotid artery has been used in the past as a treatment for cranial base and facial arteriovenous malformations. By current selective embolization techniques, this prior ligation of the external carotid artery may hinder optimal treatment. Reported here are the indications and surgical techniques used for reconstructing previously ligated external carotid arteries in preparation for endovascular treatment. Direct reconstruction or an interposition graft was useful, depending on the patient's anatomy. There were no complications in this series, despite the presumed increase in blood flow to the arteriovenous malformation after reconstruction. After reconstruction, early embolization is feasible and may be necessary to prevent the engorgement of the arteriovenous malformation.