Transarterial embolization of mandibular arteriovenous malformations using ONYX.
OBJECTIVE
To document the efficacy of ethylene vinyl alcohol copolymer (ONYX; ev3/Covidien, Irvine, CA) in the treatment of arteriovenous malformations (AVMs) of the mandible.


METHODS
A retrospective consecutive series of patients with facial AVMs isolated to the mandible and immediate perimandibular tissue was identified at 2 institutions. The primary treatment modality of transarterial embolization using ONYX was performed by way of the external carotid artery branches. Staged procedures were accomplished until no arteriovenous shunt remained. A 1-year follow-up angiogram was obtained for each patient.


RESULTS
Three patients, aged 8 (patient 1), 16 (patient 2), and 17 (patient 3) years presented with bleeding from facial AVMs isolated to the mandible. Patient 1 was female and patients 2 and 3 were male. The 2 older patients had loose molar or canine dentition. Transarterial embolization with ONYX achieved complete angiographic closure of the arteriovenous shunt in each patient. A total of 1, 6, and 3 staged embolization procedures were performed in the 3 patients. Patient 2 had mild transient facial numbness after embolization that completely resolved. Patient 3 had loose molars associated with the AVM that were extracted for treatment of intraprocedural bleeding. The 1-year angiographic follow-up data demonstrated durable closure of all 3 lesions.


CONCLUSIONS
Transarterial embolization of high-flow intraosseus mandibular AVMs was safely accomplished with ONYX in our small retrospective cohort. Complete, durable occlusion was found on the angiogram at 1 year, with clinical stability extending to an average of 3 years. Surgical resection of the AVM was avoided in all 3 patients.
Attending Physician, Interventional Neuroradiology Unit, Department of Diagnostic Imaging, Monash Medical Center, Monash Health, Melbourne, Victoria, Australia.
Ronil V
RV
Chandra
Instructor of Neurology, Neurointerventional Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Thabele M
TM
Leslie-Mazwi
Associate Professor of Radiology, Division Chief Interventional and Neurointerventional Radiology, Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Darren B
DB
Orbach
Professor of Oral and Maxillofacial Surgery, Department Head OMFS, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Leonard B
LB
Kaban
Associate Professor of Radiology, Neurointerventional Service and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: jrabinov@partners.org.
James D
JD
Rabinov
D000293:Adolescent; D001165:Arteriovenous Malformations; D002648:Child; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011145:Polyvinyls / Q000627:therapeutic use*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer