Background
Arteriovenous malformations (AVMs) are vascular anomalies characterized by shunting of blood from arterial to venous circulation by one or more fistulae. Advances in interventional techniques have rendered them more amenable to treatment. Anesthesia care of these patients is often challenging due to high cardiac output states warranting invasive monitoring, the need for complex airway management, multiple anesthetics, difficult pain management and special concerns with sclerosing agents. Aim of this study is to review the anesthetic management of patients undergoing treatment ofl AVMs, to determine challenges and perioperative complications.
			
Methods	
After IRB approval we conducted a retrospective study on patients who underwent interventional treatment for extracranial AVMs (head and neck, peripheral regions) at our institution from 2010-2016. Data collected included patient demographics, anesthetic techniques, airway management, invasive monitoring, sclerosing/embolizing agents used and perioperative complications. Descriptive statistics were used for analysing the data. 
		
Results
Total of 92 patients underwent 132 procedures (mean age 65.48 years, 51 female). Fifty patients had AVMs in the head and neck region and 42 patients had peripheral AVMs (Table1). All procedures were carried out in the interventional radiology suite and most patients needed general anesthesia. Complex airway management was needed in 11 patients including nasal intubation (4), tracheostomy (1) and use of video-laryngoscope (6). Six patients in peripheral group presented with high output cardiac failure needing invasive cardiac output monitoring.  Bleomycin was used as sclerosing agent in all head and neck AVMs and alcohol was commonly used for peripheral AVMs. Most complications were minor except for unexpected intensive care admission (n=2) with exacerbation of cardiac failure, secondary to hemodynamic disturbances with use of alcohol and severe postoperative pain needing hospitalization (4).
	
Conclusions 
Extracranial vascular anomalies are rare and occasionally complex lesions. Anesthetic management of these patients can be challenging; main issues being underlying heart failure and location of the malformations. Although overall risk of complications is low, background knowledge of these potential occurrences and their management is useful for all anesthesiologists.

Anesthetic challenges during interventional management of extra-cranial vascular malformations