Endovascular Management of a Mandibular Arteriovenous Malformation in a Patient with Severe Hemophilia A
Goetz Benndorfa,
Doris M. Kimb,
Horst Mennekingb and
Martin Kleinb
a Department of Radiology, Virchow Hospital, Charité, Humboldt University, Berlin, Germany
b Department of Maxillofacial Surgery, Virchow Hospital, Charité, Humboldt University, Berlin, Germany
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FIG 1. Initial arteriogram.
A, Left facial arteriogram. Lateral view shows opacification of an AV-shunt lesion with early filling of a giant venous varix (asterisk), supplied by numerous small pedicles from the facial artery (large arrow).
B, Left internal maxillary arteriogram. Lateral view reveals the fistulous AV shunt between a tortuous inferior dental artery (large arrow), revealing the intraosseous location, and the aneurysmal pouch (asterisk) of the mandibular vein (small arrow).
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FIG 2. Embolization and dental surgery.
A, Left mandibular phlebogram (nonsubtracted view) after direct puncture of the venous varix with an 18-gauge needle (white arrow). The AV shunt is significantly reduced after transarterial embolization and additionally diminished by external compression of the draining vein (arrows) with a metal clamp.
B, Three-dimensional reconstruction obtained by rotational radiography after intralesional injection of NBCA shows the glue cast in the feeding artery (black arrow), the giant venous pouch (asterisk), and the draining vein (mental vein; white arrow).
C, Left external carotid control arteriogram reveals the complete occlusion of the AV shunt.
D, After detaching the mucoperiost flap in the premolar/molar areas, left lower jaw. The glue-filled venous pouch of the AVM (asterisk) is surrounded by the partly loosened osseous lamella and can be removed without significant blood loss.
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