Treatment of high-flow arteriovenous malformations (AVMs) of the head and neck with embolization and surgical resection

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COD: 253-260 Categorie: ,

Valentina Pompa, Valentino Valentini, Giorgio Pompa, Stefano Di Carlo, Luciano Bresadola

Ann. Ital. Chir., 2011 82: 253-259

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AIM: Arteriovenous malformations (AVMs) with a high flow of the head and neck are quite rare compared to their lowflow
counterparts, but when they do occur they are often accompanied by massive bleeding or present with significant
esthetic defects. The treatment of these high-flow vascular anomalies is often highly risky. The multidisciplinary approach
required for the assessment and treatment of these lesions should include angioradiology with preoperative superselective
embolization, followed by surgical resection of the lesion within 24 hours and esthetic reconstruction.
MATERIALS OF STUDY: We studied a series of 55 patients with AVMs of the head and neck that were treated surgically
between 1999 and 2009.
RESULTS: Of the 55 patients with AVMs, 7 had hemangiomas and 48 had vascular malformations, of which 28 were
low-flow lesions and 20 were high-flow lesions (AVMs). The high-flow lesions were most commonly located on the lip.
All 48 AVMs underwent surgical resection for concerning symptoms, diagnostic purposes, or esthetic problems. Of the 20
high-flow AVMs, 20% were classified as Schöbinger stage I, 55% as stage II, and 25% as stage III. A combined treatment
of embolization and resection was used to resolve 13 of the high-flow AVMs (stages II and III), of which 4
required a flap reconstruction.
CONCLUSION: Recent advances in microsurgery and interventional angioradiology have greatly improved the prognosis for
patients with these malformations. Combined embolization-resection is the treatment of choice for high-flow AVMs, and
esthetic reconstruction with flaps can prevent their recurrence.

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