A challenging arteriovenous malformation of the external ear
![](https://www.bostonscientific.com/en-IN/products/embolization/Direxion_Microcatheters/case_library/challenging_arteriovenous_malformation/_jcr_content/maincontent-par/image.img.case1_1.jpg)
Baseline Central
A young girl with a serious Arteriovenous Malformation (AVM) of the left ear, principally filled by the auricolar artery, underwent angiographic treatment.
The angiographic evaluation showed two small vessels filling the nidus with a winding anatomy.
![](https://www.bostonscientific.com/en-IN/products/embolization/Direxion_Microcatheters/case_library/challenging_arteriovenous_malformation/_jcr_content/maincontent-par/image_6.img.case1_2.jpg)
Embolization
After discarding any dangerous anastomoses which could have prevented the treatment, a Direxion™ Torquable Microcatheter and a Fathom™-16 guidewire were used to select distally one of those tiny branches.
Despite the high flow area we were able to cannulate the superior vessel and inject Glue.
![](https://www.bostonscientific.com/en-IN/products/embolization/Direxion_Microcatheters/case_library/challenging_arteriovenous_malformation/_jcr_content/maincontent-par/image_7.img.case1_3.jpg)
Result
In order to preserve the natural vascularization of the ear and prevent contrast and dose issues we decided to treat the inferior vessel in a second treatment.
Thanks to the handling of the microcatheter, obtained with the nitinol hypotube technology, we were able to easily engage and navigate in this tortuous anatomy.
Dr. Alfonso Marchianò – Chief of Interventional Radiology Department & Interventional Radiologist - IRCCS Istituto Nazionale dei Tumori" – Milano
Dr. Carlo Spreafico - Interventional Radiologist - "IRCCS Istituto Nazionale dei Tumori" – Milano