Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Vanessa F Schmidt; Max Masthoff; Richard Brill; Peter B Sporns; Michael Köhler; Victor Schulze-Zachau; Martin Takes; Denis Ehrl; Daniel Puhr-Westerheide; Wolfgang G Kunz; Mwivano Dunstan Shemwetta; Eric M Mbuguje; Azza A Naif; Abizer Sarkar; Jens Ricke; Max Seidensticker; Walter A Wohlgemuth; Moritz Wildgruber

doi:10.1007/s00270-022-03169-0

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Cardiovasc Intervent Radiol. 2022 Jul;45(7):992-1000. doi: 10.1007/s00270-022-03169-0. Epub 2022 Jun 2.

Authors

Vanessa F Schmidt¹, Max Masthoff², Richard Brill³, Peter B Sporns⁴, Michael Köhler², Victor Schulze-Zachau⁴, Martin Takes⁴, Denis Ehrl⁵, Daniel Puhr-Westerheide⁶, Wolfgang G Kunz⁶, Mwivano Dunstan Shemwetta⁷, Eric M Mbuguje⁷, Azza A Naif⁷, Abizer Sarkar⁷, Jens Ricke⁶, Max Seidensticker⁶, Walter A Wohlgemuth³, Moritz Wildgruber⁶

Affiliations

¹ Department of Radiology, University Hospital, LMU Munich, Munich, Germany. Vanessa.Schmidt@med.uni-muenchen.de.
² Clinic for Radiology, University Hospital Muenster, Muenster, Germany.
³ Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.
⁴ Department of Neuroradiology, Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
⁵ Department of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Munich, Germany.
⁶ Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
⁷ Department of Radiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.

Abstract

Purpose: To evaluate the safety and outcome of image-guided embolotherapy of extracranial arteriovenous malformations (AVMs) primarily affecting the face.

Materials and methods: A multicenter cohort of 28 patients presenting with AVMs primarily affecting the face was retrospectively investigated. Fifty image-guided embolotherapies were performed, mostly using ethylene-vinyl alcohol copolymer-based embolic agents. Clinical and imaging findings were assessed to evaluate response during follow-up (symptom-free, partial relief of symptoms, no improvement, and progression despite embolization), lesion devascularization (total, 100%; substantial, 76-99%; partial, 51-75%; failure, < 50%; and progression), and complication rates (classified according to the CIRSE guidelines). Sub-analyses regarding clinical outcome (n = 24) were performed comparing patients with (n = 12) or without (n = 12) subsequent surgical resection after embolotherapy.

Results: The median number of embolotherapy sessions was 2.0 (range, 1-4). Clinical outcome after a mean follow-up of 12.4 months (± 13.3; n = 24) revealed a therapy response in 21/24 patients (87.5%). Imaging showed total devascularization in 14/24 patients (58.3%), including the 12 patients with subsequent surgery and 2 additional patients with embolotherapy only. Substantial devascularization (76-99%) was assessed in 7/24 patients (29.2%), and partial devascularization (51-75%) in 3/24 patients (12.5%). Complications occurred during/after 12/50 procedures (24.0%), including 18.0% major complications. Patients with subsequent surgical resections were more often symptom-free at the last follow-up compared to the group having undergone embolotherapy only (p = 0.006).

Conclusion: Image-guided embolotherapy is safe and effective for treating extracranial AVMs of the face. Subsequent surgical resections after embolization may substantially improve patients' clinical outcome, emphasizing the need for multimodal therapeutic concepts.

Level of evidence: Level 4, Retrospective study.

Keywords: AVM; Embolization; Face; Interventional radiology; Surgical resection.

Publication types

Multicenter Study

MeSH terms

Arteriovenous Malformations* / diagnostic imaging
Arteriovenous Malformations* / therapy
Cohort Studies
Embolization, Therapeutic* / methods
Humans
Retrospective Studies
Treatment Outcome