Fig. 1

Angiograms in Case 1 showing high-flow AVMs with multiple shunts between the arterioles and venules as a complex vascular network (Cho’s classification type IIIb) in the left upper lip and cheek. The AVMs were fed by bilateral FAs and the left ICA and drained into bilateral facial and angular veins. a Right facial arteriogram, lateral view, before the first embolization session. Arrow indicates the right SLabA. b Pre-embolization left external carotid arteriogram before the first session. The microcatheter was navigated to the distal feeder from the right SLab A (arrow). c DSA, lateral view, during injection of nBCA under flow control. The nBCA-lipiodol mixture filled the shunting points and the distal draining veins (arrow). d Left external carotid arteriogram after embolization of the right FA after the second session showing devascularization of the AVM. e External carotid arteriogram, lateral view, after embolization of bilateral Slab As showing residual AVMs fed by the IOA (black arrow), greater palatine artery (white arrow), and transverse FA (arrowhead). f Left external carotid arteriogram after embolization of the left IOA from the left MA during the fifth session showing disappearance of the AVM. g Pre-embolization left internal carotid arteriogram during the fifth session. Arrow indicates the angular (lateral nasal) artery originating from the ophthalmic artery. Microcatheter was navigated into distal segment of the feeding artery (arrowhead). h Post-embolization after the fifth session. Left internal carotid arteriogram showing disappearance of the AVM without distal embolism into the cerebral artery and retinal artery (arrow: preserved retinal blush on a magnified image during the venous phase)