Absolute Ethanol Embolisation of Mandibular Arteriovenous Malformations Following Direct Percutaneous Puncture and Release of Coils via a Microcatheter

Publication date: Available online 7 March 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): D. Wang, L. Su, Y. Han, Z. Wang, L. Zheng, X. Fan
Objective/BackgroundTo evaluate the safety, efficacy, and medium-term outcome of a modified technique of ethanol embolisation of mandibular arteriovenous malformations (AVMs) following a direct percutaneous transvenous approach to the release of coils via a microcatheter.MethodsFrom January 2012 to July 2014, 18 consecutive patients (mean age 20.9 years [range 10–35 years]) with symptomatic AVMs of the mandible were enrolled. A microcatheter was inserted into the lesion via a direct percutaneous puncture needle. Electrolytically detachable coils and 0.018 mm coils were super-selectively placed to decrease the flow and volume of the arteriovenous fistulas via a microcatheter. Absolute ethanol was injected to obliterate the fistulas. Clinical follow-up was performed in all patients. Therapeutic outcomes were determined by evaluating the degree of devascularisation at follow-up angiography and symptoms and signs.ResultsTransvenous release of coils combined with absolute ethanol embolisation were used in all cases. The amount of ethanol used ranged from 5 to 50 mL (mean 25.7 mL) in a single session. Sixteen of 18 patients were cured, and two had partial remission. Follow-up times ranged from 8 to 26 months (medium 15.7 months), and there was no angiographic recurrence of the lesions. Minor complication occurred in five of the 18 patients. There were no major complications.ConclusionAbsolute ethanol embolisation following a direct percutaneous transvenous approach to release coils via a microcatheter is a feasible, safe, and highly effective method for the management of mandibular AVMs.



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