Congenital Subclavian Arteriovenous Malformation Causing Cardiac Failure in an Adult

Treatment of Large Arteriovenous Malformation in Right Lower Limb

“…Finally, AVM may lead to cardiac decompensation and death, if not treated. A large AVM with a significant shunt between the artery and the vein causes a chronic volume overload of the heart, which leads to remodeling, ventricular dilatation, and heart failure [4]. Our patient was presented with extensive AVM involving the right lower limb, which induced limb length inequality, significant pain of the affected lesion, and moderate cardiomegaly.…”

“…Many AVMs regress spontaneously. Although smaller AVMs are usually asymptomatic, larger AVMs may cause cosmetic disfiguration, functional impairment, distal ischemia, and even hemorrhage due to ulceration in the limb [3,4]. Finally, AVM may lead to cardiac decompensation and death, if not treated.…”

“…Symptomatic AVMs may be treated using techniques such as percutaneous sclerotherapy, endovascular embolization, or surgery [3,4]. Complete eradication of the nidus of AVM has been known to be the only option for a potential cure.…”

“…Embolization has been commonly used for reducing the vascularity of extensive AVM before surgery. Anoop et al [4] reported a case of huge subclavian AVM causing heart failure, which was treated using embolization followed by surgical resection. In our patient, preoperative embolization was also attempted, but it failed due to a decompensated cardiac function that was unable to withstand an abrupt increase in the SVR at the moment of pressure application to the right proximal thigh using a tourniquet for catheter embolization.…”

Propranolol as a potentially novel treatment of arteriovenous malformations

“…1 , 2 AVMs can be either asymptomatic or cause intense pain or bleeding and can lead to serious medical problems. 3 , 4 The diagnosis of an AVM involves a combination of vascular imaging studies, such as Doppler ultrasound, computerized axial tomography, magnetic resonance angiography, and histologic examination of tissue biopsies. The clinical management of an AVM ranges from conservative approaches for asymptomatic AVMs and AVMs with minor symptoms to percutaneous sclerotherapy, endovascular embolization, or surgery, which is often required for symptomatic AVMs.…”