Large arteriovenous malformations of the face: Aesthetic results with recurrence control

Large facial arteriovenous malformations are problematic for patients becau se of grotesque disfigurement, risk of rapid enlargement, and life-threaten ing rupture. Successful treatment of these relentless complex lesions is on e of the most difficult challenges facing plastic surgeons. From a series o f 300 large facial arteriovenous malformations, 85 patients were treated wi th embolization and excision; six of these cases (representing six separate anatomic regions: labial, auricular, eyelid, cheek, chin, and occipitopari etal) were selected for review. The purpose of this article was to look cri tically at the management of these six facial arteriovenous malformations, including patient presentation, angiographic procedures, surgical planning and technique, and postoperative long-term follow-up care. Lessons learned from the six representative cases provide clues for the man agement of large facial arteriovenous malformations and demonstrate the pos sibilities of recurrence and their occasionally relentless behavior. The ca ses show that long-term control of these lesions with acceptable aesthetic results can be achieved. The mainstay of treatment includes the following: (1) selective intraarterial embolization with fine catheters and direct les ional embolization; (2) judicious resection and reconstruction with local o r expanded tissue flaps; and (3) careful follow-up with serial examinations , duplex, and arteriography.