Vascular anomalies are lesions caused by neoplastic or misshapen growth of vascular tissue and can occur anywhere in the body. It is a high blood flow vascular malformation that occurs in the oral and maxillofacial jaws, tongue, floor of the mouth and facial muscles, and consists of large and tortuous vessels and arteriovenous fistulas. Since 1995, our hospital has been using transcatheter super-selective arterial embolization to treat patients with oral and maxillofacial high blood flow type vascular malformations with satisfactory results. Most of them occur in facial skin, subcutaneous tissues and oral mucosa, such as tongue, lips and floor of mouth, and a few occur in the jaw bone or deep tissue. According to their clinical manifestations and histological characteristics, hemangiomas can be generally divided into capillary hemangiomas, cavernous hemangiomas and trabecular hemangiomas, among which capillary hemangiomas and cavernous hemangiomas are more common. The arteriovenous hemangioma of the oral and maxillofacial region, also known as arteriovenous malformation, is a high-flow type of vascular malformation, which requires various investigations before treatment, including ultrasonography, MRA and digital subtraction angiography (DSA). Radical treatment of arteriovenous malformations is difficult. Ligation of the feeding artery will reduce the resistance to flow in the area of the malformation, with the result that blood from the surrounding microfistula will return to the larger fistula, increasing the size of the malformation and aggravating the lesion. Ligation of the ipsilateral external carotid artery, due to the sudden decrease in pressure of the artery on the ligated side, hemodynamically induces the expansion and opening of the anastomotic branch between it and the contralateral external carotid artery, and even the internal carotid artery and vertebral artery, forming an extensive collateral circulation, which in turn increases the blood supply to the lesioned area, and therefore should be strongly opposed. In recent years, the application of selective arterial embolization has made the treatment of arteriovenous malformations possible. The angiography can locate, measure the scope and depth, and show the blood supplying arteries of high blood flow type vascular malformation in oral and maxillofacial area, so as to provide more accurate and reliable basis for surgery, and super-selective embolization treatment can create better conditions for surgery and reduce intraoperative bleeding. The ischemic swelling of the lesion after embolization makes it easier to peel off during surgery, shortening the operation time and reducing complications. Vascular lesions of the jaws are often seen with extractions, local biopsies or minor trauma or sudden spontaneous bleeding, where medication is difficult to stop the bleeding, and surgical treatment is the most effective means of completely curing such lesions. The patients we treat are highly regarded by clinicians. The lesions on the tongue, floor of the mouth or deep intermuscular lesions are mostly large, diffusely distributed and poorly defined, so interventional embolization can achieve the desired effect. Particularly complex lesions need to be embolized in stages to achieve therapeutic goals. Oral and maxillofacial high-flow vascular malformations are similar to intracranial AVM angiography, and generally have obvious malformed vascular masses (nests), consisting of malformed vessels of uneven thickness and disorderly course, and often are supplied by multiple arteries from the external carotid arteries bilaterally, with one side predominating. There may be one to two early-appearing veins present. In this group of cases, no draining veins were observed within 1 s. In three cases, thicker draining veins appeared 1 to 2 s after contrast injection, and most of them were vaguely observed around 3 s or later. The number and thickness of the malformed vessels, the intensity of staining, and the early and late development of the draining veins and their thickness are positively correlated with the amount of blood flow. The high blood flow type of hemangioma in the jaws was once called “central hemangioma of the jaws”. The blood supply artery is mostly the alveolar artery from the internal maxillary artery, and the external maxillary artery and lingual artery can also participate in the blood supply. In lesions with rich blood supply, vascular clusters and blood sinuses of different sizes and shapes in the contour area of the jaw can be clearly observed, and the parenchymal phase staining is obvious. In three patients in this group, the lesions were small mainly in the medullary cavity of the body of the jaws, supplied by the alveolar artery, with slender and disorganized tumor vessels in the arterial phase and lamellar staining in the parenchymal phase. Signs of arteriovenous fistula could not be observed. After successful femoral artery puncture by Seldinger technique, a catheter is sent to insert bilateral carotid arteries for comprehensive head and neck angiography (DSA) to understand the scope of lesion, blood supply, presence of arteriovenous fistula and collateral circulation, etc., to make a clear diagnosis. Then, a microcatheter is sent to the distal segment of the diseased blood supply artery, and embolization materials such as spring ring, polyvinyl alcohol (PVA) particles, gelatin sponge or even NBCA are injected through the catheter to embolize the malformed vascular mass (nest) until the DSA examination confirms the satisfactory effect. Intraoperative embolization agent selection Interventional embolization treatment of high blood flow type vascular malformation is aimed at embolizing the malformed vascular mass (nest), while only occlusion of the blood supply artery trunk cannot play a therapeutic effect. In the case of high-flow vascular malformations of the soft tissues of the maxillofacial region, the superficial skin may be involved, or the diseased blood supply artery may also supply blood to the normal skin. For larger lesions confined to deep soft tissues, the use of NBCA embolization therapy is relatively safe and effective. 1.Preoperative embolization mainly uses gelatin sponge Gelatin sponge is inexpensive, easy to prepare, and can be cut into pieces of any size as needed, which is one of the ideal preoperative embolization agents. The 1×1cm diameter granules are most widely used. For the malformed vascular mass (nest) with particularly large blood flow, 1×1cm and 2×2cm granules can be used to embolize the malformed vascular mass alternately. Smaller lesions occurring in the jaws, with relatively small malformed vessels and blood supply arteries, should be embolized with pellets ≤1×1cm. 2, radical embolization mainly uses 500-700um diameter PVA particles It is important to choose the appropriate PVA particles. Currently commercially available PVA particles have a variety of different sizes, the smallest particle diameter of 45-150 um, the largest of 1000-1180 um. Li Yanhao et al. believe that: the drainage vein in 1 to 2S developed with 500-700um particles; 2-3s developed with 350-500um particles; more than 3s available with a diameter of 200-300um. Those who develop within 1s can use tissue gel type embolic agent instead. The time of developing the draining vein is influenced by many factors, except for the presence or absence of fistula and the size of the fistula, the size of the malformed vascular mass and its vascular diameter, and the concentration and dosage of the contrast agent. In our actual clinical work, in order to avoid skin misembolism, reduce postoperative pain and shorten the operation time, we choose PVA particles of one size larger than the above-mentioned standard during treatment, and the results are satisfactory. In this group of AVM patients, the draining veins are mostly shown around 3S or later during the imaging, so the main use of 500-700um diameter PVA pellets and other diameters of PVA pellets are combined appropriately. The use of a higher dose of contrast agent for external carotid artery imaging before embolization is helpful to observe the lesion and show whether there is a “dangerous anastomosis”, which can avoid false embolization to the maximum extent. The contrast injection rate is increased by 1ml/s and the total amount is increased by 2ml, which is still safe and effective, and it is easier to show the collateral circulation vessels. The distal segment of the external carotid artery and the beginning of its branches have large curvature, and the conventional single-curved contrast catheter has high stiffness and large diameter, so further super-selective insertion after the beginning of the external carotid artery is likely to cause vasospasm and thus affect the subsequent embolization treatment. The microcatheter can be used for further superselection of the target vessel to maximize the superselection; the microcatheter has a thinner diameter, leaving a larger gap between the microcatheter and the vessel wall, and the impact of blood flow makes it easier for the injected embolic agent to drift forward and gather more densely in the malformed vessel to achieve a good therapeutic effect.