An Interdisciplinary Approach to Treatment of Adult Facial Arteriovenous Malformations: A Review of the Literature and A Single Institution's Experience With "Late" Surgical Resection and Aesthetic Reconstruction

Rachel Pedreira, Joseph Lopez, Benjamin T. Ostrander, Monica Pearl, Katherine Puttgen, Aylin Tekes, Amir H. Dorafshar

Research output: Contribution to journalArticle

Abstract

Background:Arteriovenous malformations (AVMs) are high flow vascular anomalies that are difficult to manage given their high recurrence rate. At this time, the optimal treatment of AVMs involves embolization and surgical resection. However, few studies have examined patient outcomes after a delayed surgical resection approach.Methods:A retrospective chart review of all patients presenting to a single institution with vascular malformations from 2000 to 2016 was performed. Patients with facial AVMs that underwent operative management were included. Records were reviewed for patient characteristics, lesion natural history, operative timing after embolization (<72 vs >72 hours), and outcomes.Results:11 patients fulfilled the inclusion/exclusion criteria. Nine patients were female, with an average age at resection of 29.1 years. Three patients had hemi/mid-facial AVMs, 1 patient had a nasal AVM, 3 patients had labial AVMs, 1 patient had an AVM on the chin, and 1 had a periorbital AVM. Average time between embolization and primary resection was 8.6 days (range 1-24). No complications requiring reoperation occurred in any patient. Average follow-up was 32.6 months, with 2 recurrences at a mean of 47.6 months. Timing of resection, Schobinger stage, and resection completeness did not significantly affect recurrence (P>0.05). Lesion size >6 cm in any dimension was significantly associated with recurrence (P=0.018).Conclusion:Compared to early resection, delayed (>72 h) surgical resection after embolization of facial AVMs is a viable treatment option and results in non-inferior recurrence rates (25 vs 14% respectively over a 40-month period).

Original languageEnglish (US)
Pages (from-to)1635-1639
Number of pages5
JournalJournal of Craniofacial Surgery
Volume30
Issue number6
DOIs
StatePublished - Sep 1 2019

Fingerprint

Arteriovenous Malformations
Esthetics
Recurrence
Therapeutics
Chin
Vascular Malformations
Lip
Natural History
Reoperation
Nose
Blood Vessels

Keywords

  • Arteriovenous malformation embolization
  • arteriovenous malformations
  • facial reconstruction
  • facial vascular malformations

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

An Interdisciplinary Approach to Treatment of Adult Facial Arteriovenous Malformations : A Review of the Literature and A Single Institution's Experience With "Late" Surgical Resection and Aesthetic Reconstruction. / Pedreira, Rachel; Lopez, Joseph; Ostrander, Benjamin T.; Pearl, Monica; Puttgen, Katherine; Tekes, Aylin; Dorafshar, Amir H.

In: Journal of Craniofacial Surgery, Vol. 30, No. 6, 01.09.2019, p. 1635-1639.

Research output: Contribution to journalArticle

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abstract = "Background:Arteriovenous malformations (AVMs) are high flow vascular anomalies that are difficult to manage given their high recurrence rate. At this time, the optimal treatment of AVMs involves embolization and surgical resection. However, few studies have examined patient outcomes after a delayed surgical resection approach.Methods:A retrospective chart review of all patients presenting to a single institution with vascular malformations from 2000 to 2016 was performed. Patients with facial AVMs that underwent operative management were included. Records were reviewed for patient characteristics, lesion natural history, operative timing after embolization (<72 vs >72 hours), and outcomes.Results:11 patients fulfilled the inclusion/exclusion criteria. Nine patients were female, with an average age at resection of 29.1 years. Three patients had hemi/mid-facial AVMs, 1 patient had a nasal AVM, 3 patients had labial AVMs, 1 patient had an AVM on the chin, and 1 had a periorbital AVM. Average time between embolization and primary resection was 8.6 days (range 1-24). No complications requiring reoperation occurred in any patient. Average follow-up was 32.6 months, with 2 recurrences at a mean of 47.6 months. Timing of resection, Schobinger stage, and resection completeness did not significantly affect recurrence (P>0.05). Lesion size >6 cm in any dimension was significantly associated with recurrence (P=0.018).Conclusion:Compared to early resection, delayed (>72 h) surgical resection after embolization of facial AVMs is a viable treatment option and results in non-inferior recurrence rates (25 vs 14{\%} respectively over a 40-month period).",
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