Giant arteriovenous malformation located on the chest wall — Diagnosis and endovascular treatment: Report of a case

Abstract

Congenital arteriovenous malformations are usually found in the lower extremities, but a chest wall location is extremely rare. Extensive vascular malformations present difficulties for patients because of severe unsightliness and life-threatening bleeding. Surgical planning and therapeutic indications in vascular malformations are still a difficult problem. This report describes the case of a 27-year-old woman with a congenital giant arteriovenous malformation of the left chest wall. Preoperative embolization was planned prior to surgical intervention because of the increased risk of massive bleeding, and the malformation was completely embolized with absolute alcohol.

Endovascular embolization for managing a massive shoulder arteriovenous malformation

“…In general, the goal of managing peripheral AVMs is to devascularize these vascular structures using different embolotherapy approaches that employ either the arterial or venous side of the AVM or via direct nidal injection. Importantly, the embolotherapy is generally staged on multiple sessions in order to minimize the risk of ischemic complications of the adjacent tissues [ 1 , 7 ].…”

“…Because most peripheral AVMs have complex nidus and morphology, coils are often combined with the polymerizing and/or sclerosing agents to facilitate occluding the feeding arteries. The combination of coils and NBCA was used in our case, given the complexity, and the extension of AVM [ 1 , 4 , 7 ].…”

“…NBCA is usually combined with ethiodized oil (lipiodol) in order to slow the polymerization time. The mechanism of action is linked to its mechanical and chemical effects leading to devascularization of the AVM, a merit that helps in controlling the post embolization bleeding [ 1 , 7 , 8 ].…”

Surgical Treatment with or without Embolotherapy for Arteriovenous Malformations

“…Imaging is also useful in cases with multiple lesions and can identify complications, including hemorrhage. 7 Angiography is the gold standard tool for identifying the feeding arteries and flow status of arteriovenous fistulae.…”

“…Preoperative embolization is useful and effective for reducing the incidence of intraoperative hemorrhage, thereby improving surgical outcomes and decreasing the recurrence rate in the long term. 7 In our series, we performed preoperative embolotherapy prior to surgery in one out of two thigh cases. One patient was treated with primary excision, and the amount of intraoperative blood loss in that case measured 3,632 ml.…”