Resection Of Giant Left Shoulder Arteriovenous Malformation: A Staged Hybrid Approach
Nitya Venkat, BA, Michael Nooromid, MD, Matthew P. Jenkins, MD, Stavropoula I. Tjoumakaris, MD, Babak Abai, MD.
Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Arteriovenous malformations (AVMs) are congenital shunts between arteries and veins upstream of a capillary bed, causing high-flow hemodynamic states. AVMs of the extremities can cause important functional impairment and lead to dangerous sequelae such as venous hypertension and high-output heart failure. We present a case of peripheral giant left upper back arteriovenous malformation that was treated through a staged endovascular-open approach. Our case of a 25-year-old otherwise healthy man presented with a chief complaint of increasing left upper back AVM size over the last two years, with aborted excision by a previous general surgeon for complex vascular involvement. CT angiogram revealed a 5 cm by 18 cm by 14 cm AVM within the fat planes of the left serratus anterior and the trapezius muscles. A staged approach was employed, with serial embolizations in order to decrease blood loss during the following open resection. Through 6 serial Onyx Liquid Embolic System embolizations (Medtronic, Minnesota) followed by resection, we were able to preserve limb and upper back neuro-vascular supply. Our staged, hybrid approach preserved function, relieved discomfort and pain, while improving quality of life.
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