Endovascular management of a bleeding mandibular arteriovenous malformation by transfemoral venous embolization with NBCA

Abstract

A 13-year-old boy presented with an arteriovenous malformation (AVM) involving the left mandible that bled after intraoral biopsy. The AVM was treated on an emergency basis by primary intravenous delivery of n-butyl cyanoacrylate after transfemoral catheterization, resulting in complete anatomic and clinical cure.

fig 1.

13-year-old boy with an AVM involving the left mandible that bled after intraoral biopsy. A and B, Initial arteriograms. A, Left common carotid arteriogram, lateral view, shows opacification of an arteriovenous shunting lesion with early filling of a large venous varix (double arrow) of the left mandibular vein draining into the retromandibular vein (single arrow). B, Left internal maxillary arteriogram, lateral view, shows the venous varix (arrows) is better filled and supplied mainly by the inferior dental artery (arrowheads), revealing the intraosseous location. C–F, Studies after embolization. C, Left mandibular phlebogram shows the tip of the microcatheter navigated into the very proximal part of the vein (arrow). The glue (arrowheads), already delivered by transarterial embolization, only partially occludes the mandibular vein. D, Roadmap image shows the glue cast (arrows) after the third intravenous injection filling the entire mandibular vein. E, Left common carotid arteriogram shows complete occlusion of the AVM by the end of the procedure. F, 3D reconstruction of the left mandible (rotational digital subtraction angiogram) shows the radiopaque embolic agent within the osseous cavity. The glue is positioned in the proximal and distal vein as well as in some of the small feeding vessels (arrows).