TY - JOUR
T1 - An Interdisciplinary Approach to Treatment of Adult Facial Arteriovenous Malformations
T2 - A Review of the Literature and A Single Institution's Experience With "Late" Surgical Resection and Aesthetic Reconstruction
AU - Pedreira, Rachel
AU - Lopez, Joseph
AU - Ostrander, Benjamin T.
AU - Pearl, Monica
AU - Puttgen, Katherine
AU - Tekes, Aylin
AU - Dorafshar, Amir H.
N1 - Publisher Copyright:
© 2019 by Mutaz B. Habal, MD.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - 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).
AB - 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).
KW - Arteriovenous malformation embolization
KW - arteriovenous malformations
KW - facial reconstruction
KW - facial vascular malformations
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U2 - 10.1097/SCS.0000000000005423
DO - 10.1097/SCS.0000000000005423
M3 - Article
C2 - 30908438
AN - SCOPUS:85071433528
SN - 1049-2275
VL - 30
SP - 1635
EP - 1639
JO - Journal of Craniofacial Surgery
JF - Journal of Craniofacial Surgery
IS - 6
ER -