Case Report

Labial Arteriovenous Malformation (AVM) Treated by Embolization with Biological Glue: A Case Report from Dakar (Senegal)

by Diallo M1*, Diop AD2, Amar NI1, Ndaw MDB1, Diack A1, Ndiaye A3, Tannouri F4, Mbengue A1, Diop AN5

1Medical Imaging Department, Dakar Main Hospital, Senegal

2Medical Imaging Department, Fann University Hospital, Dakar, Senegal

3Department of Head and Neck Surgery, Dakar Main Hospital, Senegal

4Department of Radiology, Free University of Brussels, Belgium

5Gaston Berger University, Saint Louis, Senegal

*Corresponding author: Diallo M, Medical Imaging Department, Dakar Main Hospital, Senegal

Received Date: 05 December 2023

Accepted Date: 11 December 2023

Published Date: 13 December 2023

Citation: Diallo M, Diop AD, Amar NI, Ndaw MDB, Diack A, et al. (2023) Labial Arteriovenous Malformation (AVM) Treated by Embolization with Biological Glue: A Case Report from Dakar (Senegal). Arch Surg Clin Case Rep 6: 208. DOI:10.29011/2689-0526.100208

Abstract

Arteriovenous malformations (AVMs) are the rarest and most serious of vascular malformations. Radiologically, the lesion consists of a vascular "nidus", a cluster of abnormal vessels fed and drained by one or more arteries and veins dilated by increased flow. The treatment of peripheral AVMs is complex, and the choice of treatment is determined by multidisciplinary consultation, since several options are available. Embolization plays an important role in the therapeutic arsenal, and particularly the one combined with surgery.

Keywords: Arteriovenous Malformation; Embolization; Biological Glue; Dakar; Senegal.

Introduction

The arteriovenous malformations (AVMs) are the rarest and most serious of vascular malformations [1-2]. Radiologically, the lesion consists of a vascular "nidus", a cluster of abnormal vessels fed and drained by one or more arteries and veins dilated by increased flow. This nidus allows arterial and venous vessels to communicate at full channel, with "early venous return" in arteriography [3].

Despite major advances in the management of vascular malformations, the treatment of AVMs remains highly complex and requires a multidisciplinary approach. Complete eradication of the nidus is potentially the only effective treatment, but it happens to be often difficult or impossible. Surgical resection alone carries a high risk of life-threatening bleeding. Interventional radiology (embolization) is a recognized and effective treatment option, either alone or in combination with surgery [4]. Several embolization agents are available, and we report a labial AVM effectively treated by embolization with biological glue. The aim is to describe the technique used and analyze its immediate findings.

Case Presentation

A 13-year-old girl presented with a nodular swelling of the left upper hemiliped that had been evolving for several years. On palpation, the nodule was firm with a small flutter. A vascular malformation was therefore suspected, and a facial angioscan was performed secondarily to confirm the diagnosis. The protocol included multiphasic helical acquisitions after injection of an iodinated contrast medium, followed by multiplanar and 3D reconstructions. They showed an AVM of the upper lip, fed exclusively by the left superior labial artery (figure 1). No draining vein was visualized. The diagnosis of a simple AVM with a main arterial afference was accepted. After multidisciplinary consultation, it was decided to perform embolization treatment. The treatment was performed in a multipurpose angiography suite. After a right femoral vascular approach using the Seldinger method and under aseptic conditions, a catheterization of the left external carotid artery was performed with a CordisTM Cobra probe, followed by angiography showing the vascular blush at the level of the upper lip, fed exclusively by the superior labial artery. Microcatheterization of the latter with a ProgreatTM 2.4 French (Fr) microcatheter mounted on a 0.014 neurovascular microguide was performed, followed by angiography to rule out off-target embolization. Selective embolization was finally performed with 2 cc of a mixture containing 1 cc of biological glue (GlubranĀ®) and 4 cc of radio-opaque oil (Lipiodol Ultra FluideĀ®). The catheterization material was continuously perfused with glucose serum. Angiograms at the end of the procedure showed disappearance of the vascular blush at the level of the upper lip, confirming the immediate success of embolization (figure 2). There were no complications during the procedure, and the immediate after-effects were straightforward.