title: Management of a large diffuse maxillofacial arteriovenous malformation previously treated with ligation of ipsilateral arterial supply.
abstract: A 32 year-old male presented with a pulsatile facial mass with palpable thrill and audible bruit. Imaging revealed a very large diffuse left-sided facial arteriovenous malformation with extensive bilateral supply, as well as a previously ligated left external carotid artery. Endovascular treatment was required to control associated hemorrhagic events as well as for palliation and was delivered via the contralateral and ipsilateral collateral supply because of ligation of the direct route to the nidus. In addition, the patient received intravenous bevacizumab and intraarterial bleomycin therapy. Under such circumstances, endovascular embolization remains often the only option when emergent therapy for massive haemorrhage is required. Collaboration and treatment planning with head and neck surgery is imperative and should be performed from the onset, avoiding disastrous ligation of arterial feeders.
authors.affiliation: 1 Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
authors.forename: Adam A
authors.initials: AA
authors.lastname: Dmytriw
authors.affiliation: 2 Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Jin S A
authors.initials: JS
authors.lastname: Song
authors.affiliation: 3 Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Power
authors.affiliation: 3 Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Saliou
authors.affiliation: 3 Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada.
authors.forename: Karel
authors.initials: K
authors.lastname: terBrugge
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000628:therapy*; D000068258:Bevacizumab / Q000627:therapeutic use; D001761:Bleomycin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018450:Disease Progression; D004322:Drainage; D004621:Embolization, Therapeutic; D005145:Face / Q000098:blood supply* / Q000000981:diagnostic imaging*; D017809:Fatal Outcome; D006801:Humans; D008026:Ligation; D008297:Male; D019767:Maxillofacial Abnormalities / Q000000981:diagnostic imaging* / Q000628:therapy*; D014081:Tooth Extraction
chemical_list: D020533:Angiogenesis Inhibitors; D000903:Antibiotics, Antineoplastic; D001761:Bleomycin; D000068258:Bevacizumab
keywords: arteriovenous malformations; biological therapy; haemorrhage; maxillofacial abnormalities; pathologic angiogenesis