A 28-year-old male patient presented to our vascular surgery service with a large, pulsating, slowly progressive mass located in the left buttock. He had a history of a blunt trauma in the same region 6 years ago. Physical examination revealed a firm mass with about 10 cm in major diameter. The presence of thrill and dark purple skin areas over the lesion suggested arteriovenous malformation (AVM) (figure 1). Clinical suspicion was confirmed by CT angiography showing a rich subcutaneous vascular network associated with increased local volume, fat infiltration and identification of dilated inferior gluteal and internal pudendal arteries and ipsilateral internal iliac vein. The patient underwent a complete resection of the lesion and immediate reconstruction. The procedure was preceded by an arterial embolization of the left hypogastric artery. Reconstruction was performed with a gluteal fasciocutaneous flap with opposite pedicles ("Yin-Yang" type). The surgical specimen and the immediate postoperative result are shown in Figures 2 and 3, respectively. Figure 1: Preoperative aspect of arteriovenous malformation.
The authors present an unusual case of a 3-year-old girl who was diagnosed with a fast-growing brachial aneurysm due to tuberous sclerosis. The patient underwent aneurysm resection and microsurgical reconstruction with reversed greater saphenous vein graft at the same time. She had a favorable outcome, without neuromuscular deficits. Doppler ultrasonography was performed for diagnosis, vein graft selection, and postoperative follow-up. The authors believe that such combined approach may be the routine for pediatric vascular reconstructions. Finally, this reconstruction has been rarely reported in tuberous sclerosis patients.
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