Endovascular treatment of congenital arteriovenous fistulas in the parotid region using coils and absolute ethanol.

OBJECTIVE: To evaluate the clinical features and therapeutic outcomes of endovascular embolization for congenital arteriovenous fistulas (cAVFs) located in the parotid region. METHODS: Fifteen consecutive patients with parotid cAVFs who underwent endovascular embolization between September 2017 and September 2025 were retrospectively reviewed. The cohort comprised nine males and six females, including six children (median age: 4 years) and nine adults (median age: 35 years). Clinical presentations, computed tomography imaging, and digital subtraction angiography data were analyzed. The therapeutic protocol involved primary coil embolization of the dilated draining vein to achieve flow reduction, followed by the targeted administration of absolute ethanol to obliterate the residual shunt. RESULTS: The predominant clinical manifestations were pulsation (14/15, 93.3%), followed by thrill (7/15, 46.7%), elevated skin temperature (7/15, 46.7%), tinnitus (3/15, 20%), and hemorrhage (1/15, 6.7%). All patients were managed via combined embolization using detachable coils (median: 7), fibered coils (median: 21), and absolute ethanol (median: 10 mL). The complete response rate was 86.7% (13/15) at the 3-month and 6-month follow-ups after the initial treatment. At the 1-year follow-up, the final complete symptom resolution rate reached 100% (15/15) after repeat sessions in selected cases. Complications included transient localized swelling (15/15, 100%), temporary facial nerve paralysis (1/15, 6.7%), and late coil exposure via the external auditory canal (1/15, 6.7%), all of which resolved with targeted management. CONCLUSION: Endovascular embolization using a combination of coils and absolute ethanol is a clinically viable and effective strategy for the management of parotid cAVFs. While localized swelling is a universal post-procedural event, major systemic complications are rare, rendering this technique a valuable minimally invasive alternative to open surgery.