Indan Journal of Medical Research Indan Journal of Medical Research Indan Journal of Medical Research
  Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login  
  Home Print this page Email this page Small font sizeDefault font sizeIncrease font size Users Online: 5351       

   Table of Contents      
CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 78-79

Meandering through arteriovenous malformation maze: A multidisciplinary approach


Department of Radiodiagnosis & Imaging, St John's Medical College & Hospital, Bengaluru 560 034, Karnataka, India

Date of Submission15-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Abhinandhan Ruge
Department of Radiodiagnosis & Imaging, St John's Medical College & Hospital, Bengaluru 560 034, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2104_19

Rights and Permissions

How to cite this article:
Beaty S, Ruge A. Meandering through arteriovenous malformation maze: A multidisciplinary approach. Indian J Med Res 2020;152, Suppl S1:78-9

How to cite this URL:
Beaty S, Ruge A. Meandering through arteriovenous malformation maze: A multidisciplinary approach. Indian J Med Res [serial online] 2020 [cited 2021 Jul 29];152, Suppl S1:78-9. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/78/316704

Patient's consent obtained to publish clinical information and images.


A 28 yr old female presented to the Vascular and Interventional Radiology division at St John's Medical College and Hospital, Bengaluru, India, in October 2019, with painful progressively enlarging swellings over the right forearm for the past 15 years, which eventually led to deformity of the hand, ulceration and bleeding. On examination, there was clawing of the medial two fingers, ulceration and gangrenous changes of the fifth digit and audible bruit over the swellings [Figure 1]. Ultrasound Doppler study, showed a high-flow arteriovenous malformation (AVM), and digital subtraction angiography confirmed that feeders were from both ulnar and radial arteries ([Figure 2], [Figure 3]A and [Figure 3]B and Video A).
Figure 1: Multiple painful swellings of the right forearm, ulnar clawing, ulceration and gangrene of the little finger. Multiple dilated and tortuous veins, pulsatile lesions and warm mass (white arrows) with a thrill on examination were also seen.

Click here to view
Figure 2: Ultrasound image showing multiple tortuous dilated vascular channels with aliasing effect – high-flow vascular malformation.

Click here to view
Figure 3: Digital subtraction angiogram (DSA). (A) Pre-embolization selective digital subtraction angiography of the right brachial artery showing a high-flow arteriovenous malformation (AVM) with feeders arising both from radial and ulnar arteries was noted, with early opacification of multiple dilated tortuous AVM. (B) Pre-embolization selective DSA of the right ulnar artery showing feeders arising from ulnar artery, opacification of the nidus of abnormal vessels and with extension into the hand.

Click here to view


The adjunctive endovascular procedure was performed under local anaesthesia after cannulating the brachial artery via femoral access. The feeders from ulnar artery were embolized with a lipiodol-glue (2-N-butyl cyanoacrylate) combination, along with percutaneous sclerotherapy of the remnant veins ([Figure 4]A and Video B).
Figure 4: (A) Image showing endovascular embolization of the nidus performed using lipiodol-glue combination. (B) Post-embolization selective digital subtraction angiogram of the right brachial artery showing exclusion of the nidus and glue-cast filling all the feeding branches from ulnar artery and the nidus; normal opacification of the radial artery is seen with residual AVMs which was not embolized to preserve the circulation to the hand.

Click here to view


Post-embolization selective angiogram of the right brachial artery showed obliteration of the nidus and glue-cast filling all the feeding branches from the ulnar artery and nidus. Normal opacification of the radial artery was seen with residual AVM ([Figure 4]B and Video C), which was not embolized to preserve circulation to the hand. Subsequently, debulking surgery and amputation of the little finger due to gangrene were performed. Cosmetic results of the forearm post-surgery were appreciable along with symptomatic relief [Figure 5].
Figure 5: Post-debulking and amputation of little finger image of the right forearm showing significant reduction in the size of the AVMs.

Click here to view


Acknowledgment: Authors acknowledge Dr Naren, Department of Plastic Surgery, St Johns' Medical College & Hospital, Bengaluru.

Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Article Figures

 Article Access Statistics
    Viewed144    
    Printed0    
    Emailed0    
    PDF Downloaded28    
    Comments [Add]    

Recommend this journal