Nonsurgical Management of a Challenging Auricular Arteriovenous Malformation Using Serial Embolization and Sclerotherapy

Arteriovenous malformation (AVM) of the auricle is a rare, high-flow vascular anomaly that poses both therapeutic and cosmetic challenges. Surgical excision is often recommended but may result in significant deformity, especially when total ear amputation is required for complete nidus removal. We report a case of recurrent and extensive auricular AVM successfully treated using staged, minimally invasive therapy without surgery. A 26-year-old man presented with multiple recurrences after 2 prior excisions. Four sessions of transcatheter arterial embolization using ethanol and N-butyl cyanoacrylate, combined with percutaneous sclerotherapy, achieved complete devascularization. Although partial auricular necrosis occurred as an expected ischemic change, the wound healed completely with conservative management, and no recurrence was observed during follow-up. This case demonstrates that carefully staged embolization and sclerotherapy alone can provide effective flow control and favorable cosmetic outcomes, offering a viable nonsurgical alternative for selected patients with auricular AVM.