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An Interdisciplinary Approach to Treatment of Adult Facial Arteriovenous Malformations

A Review of the Literature and A Single Institution's Experience With “Late” Surgical Resection and Aesthetic Reconstruction

Pedreira, Rachel, BA*; Lopez, Joseph, MD, MBA; Ostrander, Benjamin T., BS*; Pearl, Monica, MD; Puttgen, Katherine, MD§; Tekes, Aylin, MD**; Dorafshar, Amir H., MBChB, FACS, FAAP

doi: 10.1097/SCS.0000000000005423
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Background: Arteriovenous malformations (AVMs) are high flow vascular anomalies that are difficult to manage given their high recurrence rate. At this time, the optimal treatment of AVMs involves embolization and surgical resection. However, few studies have examined patient outcomes after a delayed surgical resection approach.

Methods: A retrospective chart review of all patients presenting to a single institution with vascular malformations from 2000 to 2016 was performed. Patients with facial AVMs that underwent operative management were included. Records were reviewed for patient characteristics, lesion natural history, operative timing after embolization (<72 vs >72 hours), and outcomes.

Results: 11 patients fulfilled the inclusion/exclusion criteria. Nine patients were female, with an average age at resection of 29.1 years. Three patients had hemi/mid-facial AVMs, 1 patient had a nasal AVM, 3 patients had labial AVMs, 1 patient had an AVM on the chin, and 1 had a periorbital AVM. Average time between embolization and primary resection was 8.6 days (range 1–24). No complications requiring reoperation occurred in any patient. Average follow-up was 32.6 months, with 2 recurrences at a mean of 47.6 months. Timing of resection, Schobinger stage, and resection completeness did not significantly affect recurrence (P >0.05). Lesion size >6 cm in any dimension was significantly associated with recurrence (P = 0.018).

Conclusion: Compared to early resection, delayed (>72 h) surgical resection after embolization of facial AVMs is a viable treatment option and results in non-inferior recurrence rates (25 vs 14% respectively over a 40-month period).

*Johns Hopkins University School of Medicine

Department of Plastic and Reconstructive Surgery

Department of Radiology, Division of Interventional Neuroradiology

§Department of Dermatology

**Department of Radiology, Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, MD.

Address correspondence and reprint requests to: Amir H. Dorafshar MBChB, FACS, FAAP, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, JHOC 8150, 600 North Wolfe Street, Baltimore, MD 21287; E-mail: Amir_Dorafshar@rush.edu

Received 12 July, 2018

Accepted 26 January, 2019

The authors report no conflicts of interest.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com).

© 2019 by Mutaz B. Habal, MD.