Head and Neck Endovascular Repair of Vascular Malformations

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Wayne Yakes, MD

Medical Director
The Yakes Vascular Malformation Center

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Wayne Yakes, MD: No financial relationships to disclose

Purpose: To determine the efficacy of ethanol embolotherapy of extracranial head and neck vascular malformations of all types, particularly after failure of other endovascular and surgical treatments.

Materials and Methods: One hundred and sixty-six patients (64 males, 102 females; mean age: 38 yrs) presented with extracranial arteriovenous malformations (AVMs) of the head and neck area. Over half of the patients had undergone previous failed therapies (Glue, Onyx, PVA, Coils). All patients underwent ethanol embolotherapy under general anesthesia. Forty-five patients had AVMs and 121 patients had venous malformations (VM).

Results: Of 45 AVM patients, 26 patients are cured (mean follow-up 2 ½ years); of 121 venous malformation patients, 65 are at end-therapy (mean follow-up 4 ½ years). The remaining patients are not at end-therapy and are being treated for their residual malformations. In AVM follow-up, arteriography is the main imaging modality to determine cure or residual AVM as MR is less sensitive in the evaluation of residual AVM. In VM follow-up, MR is the main imaging tool, particularly with T- 2 fat suppression and/or STIR imaging. All patients demonstrated improvement post-therapy. Complications were 4.5%, to include bleeding (self-limited), partial 7^th nerve palsy (with recovery), skin injury (not requiring skin grafts), infection, and pain.

Conclusion:

Ethanol has proven its consistent curative potential at long-term follow-up for high-flow AVMs and low-flow VM lesions at long-term follow-up as lesions in the periphery. Complication rates remain low. The procedures are tolerated well by the patients and done on an out-patient basis. Prior surgery and embolization procedures can cause difficulty in lesion access, but does not obviate further ethanol endovascular treatment.