Surgical Excision after Selective Embolization of Congenital Arteriovenous Malformation

Kim, Seong Deok; Mun, Goo Hyun; Bang, Sa Ik; Oh, Kap Sung; Hyon, Won Sok

Abstract

Arteriovenous malformation(AVM) is an abnormal communication between an artery and a vein and often causes significant hemorrhage or cosmetic problems. Treatment of these vascular anomalies is hazardous and has high incidence of recurrence. A multidisciplinary team approach is required in the assessment and treatment of the lesion, and preoperative angiography with superselective embolization followed by resection is required. The authors performed nine cases of the wide resection of the congenital arteriovenous malformation(7 on the head and neck, 2 on the trunk) between April 1998 and January 2002. All patients underwent preoperative embolization with n-butyl 2-cyanoacrylate at 1 week before operation. Preoperative embolization resulted in significant devascularization of the AVM thus leading to minimal bleeding during operation. After resection, direct closure were performed in 6 cases, skin graft in 1 case, free transverse rectus abdominis musculocutaneous flap in 1 case, and tissue expansion using tissue expander in 1case. There was one complication related with embolization procedure in temple AVM patient. No recurrence has been recognized during the follow-up period, which ranges from 16 to 61 months. Preoperative embolization with n-butyl 2-cyanoacrylate and surgical resection of the AVM provided excellent long-term palliation in patients with congenital AVM.