Combined approach to a peripheral congenital arteriovenous malformation: surgery and embolization

Toker, Mehmet Erdem; Eren, Ercan; Akbayrak, Hakan; Numan, Firuzan; Güler, Mustafa; Balkanay, Mehmet; Yakut, Cevat

doi:10.1007/s00380-005-0842-8

Cited by 18 publications

(18 citation statements)

References 10 publications

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“…The liquid embolic agent used in the present study (ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide) has been investigated for cerebral use in many studies, 10,19,22,23 but use for peripheral indications is increasing as well. 20,24–28 Peripheral uses result in clinical success in many human cases with a low complication rate. 20,25,27,28 …”

Section: Discussionmentioning

confidence: 99%

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Use of ethylene-vinyl alcohol copolymer as a liquid embolic agent to treat a peripheral arteriovenous malformation in a dog

Culp¹,

Glaiberman²,

Pollard³

et al. 2014

javma

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Case Description An 11-year-old castrated male Tibetan Mastiff was evaluated because of a visibly enlarged blood vessel and progressively worsening swelling of the right hind limb. Clinical Findings On physical examination, the right hind limb was markedly larger than the left hind limb and the dog was minimally weight bearing on the affected limb. A bruit was auscultated over the affected region. Ultrasonography of the tarsal region of the right hind limb revealed an artery with turbulent flow that communicated with venous drainage. A CT scan confirmed the presence of an arteriovenous malformation (AVM). Treatment and Outcome Embolization of the AVM with a liquid embolic agent (ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide) was elected. An arteriogram was performed prior to treatment and delineated the vessels that were targeted for embolization. The embolic agent was infused into the AVM, and a postinjection arteriogram confirmed complete occlusion of the AVM nidus and normal arterial flow to the paw with subsequent normal venous drainage. The circumference of the abnormal paw was 51 cm before the procedure and 22.9 cm at 4 weeks after the procedure. Additionally, the gait of the dog dramatically improved. No complications associated with the procedure developed. Clinical Relevance Peripheral AVMs in dogs are uncommon, and described treatment options are limited and generally associated with serious morbidity. A liquid embolic agent, ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide, was successfully administered in this case, and no morbidity was observed secondary to the procedure. Clinical success was characterized by substantial improvement in limb swelling and marked improvement in the gait of the dog.

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Section: Discussionmentioning

confidence: 99%

“…20,24–28 Peripheral uses result in clinical success in many human cases with a low complication rate. 20,25,27,28 …”

Section: Discussionmentioning

confidence: 99%

Use of ethylene-vinyl alcohol copolymer as a liquid embolic agent to treat a peripheral arteriovenous malformation in a dog

Culp¹,

Glaiberman²,

Pollard³

et al. 2014

javma

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show abstract

“…Catheterization and embolization comprise a valuable therapy for AVF and should be used as the primary technique for treatment in most cases 8 ) . The optimum treatment strategy involves surgical resection, transcatheter embolization, or a combination of the two 9 , 10 ) . However, because AVF is relatively rare, there were very few specialists in Japan.…”

Section: Discussionmentioning

confidence: 99%

A Case of Intractable Left Forearm Congenital Arteriovenous Fistula Ending with Amputation: Importance of New Medical Information Obtained via the Internet

Shimada

2014

J Rural Med

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Objective: The aim of the present study was to consider the importance of medical information obtained via the Internet for difficult cases in hospitals, especially in those located in rural areas. We report here a case of congenital arteriovenous fistula (AVF) in the upper extremities.Patient: A 30-year-old lady was transported to our hospital by ambulance due to massive bleeding in her left hand. She was seen by our current cardiovascular surgery team for the first time, although she had been diagnosed with congenital AVF of the left arm 9 years previously. Because it was asymptomatic, she was followed up by observation. During 5 years of observation, symptoms such as cyanosis, pain, and refractory ulcers gradually developed. When she was 26 years old, she was referred to a university hospital in Akita, but surgery had already been judged to be impossible. When she was 30 years old, traumatic bleeding in her left hand and hemorrhagic shock led her to be taken to our hospital by ambulance. Using the Internet, we found an institution that had treated a large number of cases of AVF. After controlling the bleeding, we referred her to that institution. However, she could not be treated without an above-elbow amputation.Conclusion: Congenital AVF in the upper extremities is a rare vascular anomaly and has been generally accepted to be an extremely difficult disease to treat. Treatment should be started as early as possible before the presence of any symptoms. When a specialist is not available near the hospital, precise information must be found using the Internet and the patient should be referred without any delay.

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“…Some lesions become apparent after trauma or during periods of hormonal stimulation such as menarche or pregnancy. 6 The diagnosis of congenital AVM can usually be made according to the patient's history and a physical examination. Confirmation is generally obtained with CT scanning, MRI or angiography.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment with or without Embolotherapy for Arteriovenous Malformations

Igari

Kudo

Toyofuku

et al. 2013

Annals of Vascular Diseases

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Objective: The management of arteriovenous malformations (AVMs) remains challenging due to the high rate of recurrence of these lesions. Surgical resection is the only potential cure; however, it is often difficult to perform and carries a risk of massive hemorrhage. The purpose of this study was to review our experience with AVMs treated by surgical resection. Materials and Methods: We retrospectively reviewed the medical records of nine patients with AVM, treated with surgical resection. We treated these patients with excision surgery with or without embolotherapy. Results: Eight were treated with surgical resection with embolotherapy and one was treated with a simple surgical resection. Five patients with AVMs were cured. However, two cases of AVM recurred after total excision, and AVMs remained in two cases of partial excisional surgery in which the lesions involved the joints. Conclusions: Total excision of AVMs leads to a cure; however, total excision is not adequate in cases of AVMs involving the joints. Multidisciplinary treatment may offer good results in reducing the morbidity. To minimize complications related to surgery, aggressive control of blood flow to the lesion, preoperatively, with appropriate embolotherapy is essential, and a complete resection with a chance of cure will be increased.

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Combined approach to a peripheral congenital arteriovenous malformation: surgery and embolization

Cited by 18 publications

References 10 publications

Use of ethylene-vinyl alcohol copolymer as a liquid embolic agent to treat a peripheral arteriovenous malformation in a dog

Use of ethylene-vinyl alcohol copolymer as a liquid embolic agent to treat a peripheral arteriovenous malformation in a dog

A Case of Intractable Left Forearm Congenital Arteriovenous Fistula Ending with Amputation: Importance of New Medical Information Obtained via the Internet

Surgical Treatment with or without Embolotherapy for Arteriovenous Malformations

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