title: Use of the radial forearm artery for secondary embolization of an extensive life-threatening arteriovenous malformation of the mid-face and anterior skull base - a case report.
abstract: BACKGROUND
  Arteriovenous malformations (AVM) of the head and neck are rare conditions with the majority of primary sites in the mid-face. Progression can lead to massive life-threatening bleeding. Treatment of choice is the combination of embolization and surgical resection. Diagnosis and management of AVM has been facilitated in recent years by the progress in imaging techniques and various microsurgical and endovascular embolization procedures.
  
  
  METHODS
  This report presents the interdisciplinary approach to a case of life-threatening AVM of the mid-face in a 30-year-old patient.
  
  
  RESULTS
  Angiography with embolization followed by resection and plastic reconstruction was performed. Follow-up showed incomplete obliteration of the AVM and lead to additional embolizations via the anastomosed radial artery. Complete eradication of the AVM was not possible during the three year follow-up period.
  
  
  CONCLUSIONS
  In extensive vascular malformations of the head and neck, complete surgical removal is often impossible and associated with high risk of complications and mortality. Endovascular embolization is limited by the location of the AVM and can potentially cause stroke, ischaemia, necrosis, bleeding, blindness and adverse haemodynamic changes.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Rainer Schmelzeisen, PhD, MD, DDS), University Hospital Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany. michael.ermer@uniklinik-freiburg.de
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ermer
authors.forename: Ralf
authors.initials: R
authors.lastname: Gutwald
authors.forename: Martin
authors.initials: M
authors.lastname: Schumacher
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmelzeisen
authors.forename: Christian
authors.initials: C
authors.lastname: Taschner
mesh_terms: D000328:Adult; D000539:Alveolar Process / Q000098:blood supply; D015901:Angiography, Digital Subtraction; D001165:Arteriovenous Malformations / Q000601:surgery / Q000628:therapy*; D002610:Cheek / Q000098:blood supply; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005123:Eye / Q000098:blood supply; D005145:Face / Q000098:blood supply*; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000601:surgery / Q000628:therapy; D006801:Humans; D008046:Lip / Q000098:blood supply; D008297:Male; D008437:Maxilla / Q000098:blood supply; D009305:Nasopharynx / Q000098:blood supply; D009333:Neck / Q000098:blood supply; D010348:Patient Care Team; D017534:Radial Artery / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D019233:Retreatment; D019291:Skull Base / Q000098:blood supply*; D013524:Surgical Flaps / Q000637:transplantation; D013961:Thyroid Gland / Q000098:blood supply; D014656:Vascular Surgical Procedures / Q000379:methods; D014711:Vertebral Artery / Q000002:abnormalities