Embolization of Extracranial Arteriovenous Malformations: Interventional Approaches according to the Yakes Classification System

Extracranial arteriovenous malformations (AVMs) are high-flow congenital malformations characterized by direct communication between arteries and veins. These shunts, depending on their size, can cause severe complications such as ischemic skin ulceration, bleeding, bone destruction, and even cardiac failure. AVMs present the greatest challenge in treatment of vascular malformations, requiring collaboration among interventional radiologists, surgeons, dermatologists, internal medicine specialists, and geneticists. This is due to the complex architecture of AVMs, which are characterized by multiple inflow and outflow vessels and their deep extension in normal tissues. Inadequate treatment can lead to high recurrence and progression rates, underscoring the importance of comprehensive multidisciplinary interventions. Advances in the genotyping of AVMs have opened the door to medical therapies that can be combined with interventional therapies. In recent years, interventional radiology has had an increasingly important role in managing, diagnosing, and treating AVMs. This expansion is due to the challenges presented by these complex lesions, which make complete surgical resection often difficult and pose a high risk of complications. A comprehensive understanding of AVM angioarchitecture is essential for enabling interventional radiologists to deliver precise and personalized treatment, minimizing the risk of recurrence and complications. This review outlines the angioarchitecture of AVMs according to the Yakes classification system, clinical and imaging assessment and treatment strategies according to angioarchitecture and anatomic localization of the lesions, and medical therapies informed by genetics. ^©RSNA, 2025 Supplemental material is available for this article. See the invited commentary by Montgomery and Saenz in this issue.