What to do when the external carotid artery was ligated years ago in a well-meaning, but entirely ineffective attempt to control bleeding from a tongue AVM? After ligation proved futile, bleeding was controlled by compression. Years later, its bleeding again. Now what?

Stump of the ECA. Reconstitution of ECA via the rotundum branch from the ILT and mandibulovidian artery, as well as short unnamed arteries bridging the stump with the lingual

Reconstitution of the ECA via the other one and the vert

What to do? Reconnect the lingual with the ECA using a venous graft. Performed by Dr. M. Adelman

Now we are in business — right side back to its intended borders, left sided AVM now resupplied by something we can go through. And not bleeding either…

Glue embo — balloon used to protect distal lingual in this pedicle

During embo

Final result

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