上颌动脉畸形的栓塞治疗：线圈和乙醇。
Embolization for Arteriovenous Malformations in the Maxilla With Coils and Ethanol.
机构信息
Vice Professor, Vice Department Head, Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, PR China.
Professor, Department Head, Department of Interventional Therapy, Multidisciplinary Team of Vascular Anomalies, Shanghai Ninth People's hospital, Shanghai Jiao Tong University, Shanghai, PR China.
出版信息
J Oral Maxillofac Surg. 2022 Nov;80(11):1841-1851. doi: 10.1016/j.joms.2022.07.139. Epub 2022 Aug 6.
PURPOSE
Maxillary arteriovenous malformations (AVMs) are uncommon, limiting comprehensive research into standard treatment protocols. This study evaluated the management, outcomes, and clinical safety of embolization techniques for maxillary AVMs, using coils and ethanol.
METHODS
In this retrospective case series, we enrolled a sample of patients with maxillary AVMs treated with embolization using coils with or without ethanol between June 2017 and July 2019. Coils were super-selectively placed into the nidus and dominant outflow vein to decrease the flow of the arteriovenous fistulas. Absolute ethanol was then injected to obliterate the nidus. Clinical follow-up was performed for all the patients, and therapeutic outcomes were measured by evaluating the degree of devascularization and symptoms.
RESULTS
Ten patients were included in the present study, including 4 men (40%) and 6 women (60%), with a mean age of 18.1 years (range, 10 to 36 years). Transvenous release of coils (9 detachable coils and 143 pushable coils), either with or without absolute ethanol embolization, was used in all the patients. The amount of ethanol injected ranged from 0 to 12 mL (mean: 6.5 mL; 95% confidence interval: 3.489 to 9.511) in a single session. Seven (70%) of the 10 patients were cured, while 3 patients (30%) had partial remission. Follow-up times ranged from 26 to 42 months (median: 29.7 months). Tooth loosening and coil exposure occurred in 7 patients (70%) and healed after surgery. No major complications were noted.
CONCLUSIONS
Coils and ethanol embolization have the potential to cure AVMs in the maxilla with an acceptable risk of minor complications.
目的
上颌动静脉畸形（AVM）较为少见，限制了对标准治疗方案的全面研究。本研究评估了使用线圈和乙醇对上颌 AVM 进行栓塞治疗的管理、结果和临床安全性。
方法
在这项回顾性病例系列研究中，我们招募了一组在 2017 年 6 月至 2019 年 7 月期间接受线圈栓塞治疗的上颌 AVM 患者。将线圈超选择性地放置在病灶和主要流出静脉内，以减少动静脉瘘的血流量。然后注入绝对乙醇以破坏病灶。对所有患者进行临床随访，并通过评估去血管化程度和症状来衡量治疗效果。
结果
本研究共纳入 10 例患者，其中男性 4 例（40%），女性 6 例（60%），平均年龄 18.1 岁（范围：10 至 36 岁）。所有患者均采用经静脉释放线圈（9 个可解脱线圈和 143 个可推送线圈），联合或不联合绝对乙醇栓塞。单次注射乙醇的量为 0 至 12 mL（平均：6.5 mL；95%置信区间：3.489 至 9.511）。10 例患者中 7 例（70%）治愈，3 例（30%）部分缓解。随访时间为 26 至 42 个月（中位数：29.7 个月）。7 例患者（70%）出现牙齿松动和线圈外露，经手术治愈。未出现重大并发症。
结论
线圈和乙醇栓塞治疗上颌 AVM 具有治愈潜力，且发生轻微并发症的风险可以接受。
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