Head and Neck Arteriovenous Malformations: Results of Ethanol Sclerotherapy

Pre- and posttreatment DSA and clinical photo of patient 1. Presclerotherapy DSA (A) shows a high-flow AVM with most of the arterial flow from still-patent proximal facial artery branches. A right ECA angiogram after 1 sclerotherapy session (B) shows a small nidus remnant (circled) with feeders from right facial and internal maxillary arteries through tortuous small-caliber vessels. This was treated during 2 subsequent sessions via intra-arterial and direct puncture access. A microcatheter angiogram through a peripheral right facial artery branch (C) exemplifies a selective access to the nidus, with visualization of only pathologic nidal arteries and outflow veins; an arrow marks the microcatheter tip. Right ECA angiogram 4 months after sclerotherapy completion (early arterial phase, D; late arterial phase, E) shows no arteriovenous shunting or pathologic vasculature, and the tortuous feeders from the internal maxillary artery have regressed. A clinical photo (F) shows a scar resulting from a skin necrosis during the second treatment.