塞栓硬化療法後に再増大を来たし拡大切除と皮弁による再建術を行った顔面動静脈奇形の1例

The Surgical Treatment for a Facial AVM that Regrew after Several Ebolo-Sclerotherapy Sessions

はじめに

　動静脈奇形（arteriovenous malformation：以下，AVM）の治療としては直接穿刺による硬化療法，手術，interventional radiology（以下，IVR）による塞栓/硬化療法，これらの組み合わせなどさまざまな選択肢があるが，AVMはいまだに治療の困難な疾患の1つである。特に頭頸部領域のAVMにおいては，視覚，聴覚，呼吸，摂食，嚥下など重要な機能が集中していること，常に外界に晒される整容的に重要な部位であることが，治療をより一層困難なものとしている。今回われわれは右鼻部に生じたAVMに対して，数回にわたる画像下治療の後に再増大を来たし，最終的に全摘術と遊離組織移植による再建術を行い，良好な結果を得た1例を経験したので報告する。

　Treatment of arteriovenous malformations (AVMs) of the face remains challenging because of the aesthetic and functional aspects of this AVM site, and thus the initial treatment of such cases tends to be performed with embolization or sclerotherapy. However, the recurrence rate is high and advanced AVMs require aggressive surgical resection. As a result, free flap reconstruction is needed in such cases.

　We provide the case details of a 27- year old man with an AVM in his right nose which had been treated with embolization or sclerotherapy 4 years before he underwent surgical treatment. Despite several sessions of ebolo-sclerotherapy treatment, the AVMʼs regrowth was observed and persistent bleeding developed. A resection of the AVM followed by immediate free anterolateral thigh flap reconstruction was performed. Although secondary scar revision was required, no evident sign of AVM recurrence has been observed during the 2 years since the resection, and a satisfactory esthetic result was obtained. Aggressive resection with appropriate reconstructive procedures can be recommended for the treatment of facial AVMs.