Treatment Of Periorbital And Palpebral Arteriovenous Malformations
Fukuoka University, Fukuoka, Japan.
To clarify clinically challenging palpebral arteriovenous malformations (AVMs) and to propose a novel therapeutic modality, we developed a multi-disciplinary approach for the management of naturally progressing to wounding and severe disfigurement and worsening with ulcer. First, the central retinal artery was secured with embolization via the trans-ophthalmic arterial, a terminal branch of the internal carotid artery (ICA), and then the branches of the external carotid artery were embolized to cause a response in the AVM vasculature followed by sclerotherapy and surgery. The effects of this strategy on minimizing the risk of major complications were evaluated. Over a three-year follow-up of five cases of palpebral and peri-orbital AVMs in four females and one male aged 20 to 50 years with a mean age of 38 years, complete remission of the lesions was seen with no major complication, such as blindness, ptosis, or cerebral infarction, with functionally sound and esthetically acceptable results with no recurrence or worsening over three years. Planned treatment of palpebral and peri-orbital AVMs, which have been often left untreated because of their complex vasculature and a risk of total blindness due to occlusion of the central retinal artery. A wait-and-watch” approach is frequently taken. It is important to secure the periphery to the bifurcation of the central retinal artery of the ICA; then, embolization through the external carotid artery (ECA) results in complete remission of the lesion, followed by sclerotherapy and surgery which are successful both in terms of function and esthetics. Therefore, we conclude trans-ophthalmic arterial embolization first to secure the central retinal artery leads to safer and complete resolution of palpebral and peri-orbital AVMs; wounding or therapeutic complications such as skin necrosis may be seen, but this approach results in complete remission in three years with no major complications.
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