Original article | Volume 33, Article 128, 21 Jun 2019 | 10.11604/pamj.2019.33.128.19258

Rapid formation of new peripheral arteriovenous malformations post-interventions

Gaurav Gheewala, Iqbal Ratnani

Corresponding author: Gaurav Gheewala, Department of Anesthesiology and Critical Care, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA

Received: 26 May 2019 - Accepted: 17 Jun 2019 - Published: 21 Jun 2019

Domain: Intensive care medicine

Keywords: AVM, arteriovenous malformation, peripheral arteriovenous malformation

©Gaurav Gheewala et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Gaurav Gheewala et al. Rapid formation of new peripheral arteriovenous malformations post-interventions. Pan African Medical Journal. 2019;33:128. [doi: 10.11604/pamj.2019.33.128.19258]

Available online at: https://www.panafrican-med-journal.com/content/article/33/128/full

Home | Volume 33 | Article number 128

Original article

Rapid formation of new peripheral arteriovenous malformations post-interventions

Rapid formation of new peripheral arteriovenous malformations post-interventions

Gaurav Gheewala1,&, Iqbal Ratnani1

 

1Department of Anesthesiology and Critical Care, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA

 

 

&Corresponding author
Gaurav Gheewala, Department of Anesthesiology and Critical Care, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA

 

 

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A 17-year-old male with a history of recurrent peripheral arteriovenous malformations (pAVMs) of right chest, axilla, and right upper extremity (RUE), presented after having multiple procedures for pAVMs and complex right shoulder wound. Being managed conservatively at first, he later underwent diagnostic angiogram and biopsy which shows ectatic vessels, hence, Onyx embolization of right subclavian, axillary, and brachial arteries was performed (A). Within two years, due to his necrotic right shoulder wound with osteomyelitis of humeral head, he underwent RUE amputation and resection of newly developed right chest pAVMs with further Onyx embolization post angiogram (B). He also required series of reconstructive procedures including tissue expander placement and subsequent muscle flap to necrotic anterior right chest wound which was measured 14x3 cm. Patient was subsequently discharged from the hospital after six months and is being followed by vascular and plastic surgery team. Other than cerebral AVMs, pAVMs are rare and get diagnosed by history, angiography, imaging studies, or biopsy. Treatment options are embolization, and/or resection, however, these interventions lead to formation of new AVMs from increasing flow to the surrounding vasculature. Therefore, patients with AVMs remain at high risk for complications despite appropriate interventions.

 

 

Figure 1: A) onyx embolization of right subclavian, axillary, and brachial arteries; B) right upper extremity amputation with further onyx embolization

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Original article

Rapid formation of new peripheral arteriovenous malformations post-interventions

Original article

Rapid formation of new peripheral arteriovenous malformations post-interventions

Original article

Rapid formation of new peripheral arteriovenous malformations post-interventions

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Key words

AVM

Arteriovenous malformation

Peripheral arteriovenous malformation

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Rapid formation of new peripheral arteriovenous malformations post-interventions