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Super Selective Embolization and Immediate Resection of a High-flow Arteriovenous Malformation in the Hand

A significant proportion of high-flow arteriovenous malformations (AVMs) in the hand are complex to treat due to their multicentricity, size, and risk of jeopardizing distal circulation. Therefore, AVMs are frequently considered “inoperable.” We present the case of a multifocal recurrent AVM treated...

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Autores principales: Reynoso, Rafael, Echeverría, Alfonso, Saldivar Rodea, Carlos Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10400054/
https://www.ncbi.nlm.nih.gov/pubmed/37547345
http://dx.doi.org/10.1097/GOX.0000000000005159
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author Reynoso, Rafael
Echeverría, Alfonso
Saldivar Rodea, Carlos Alberto
author_facet Reynoso, Rafael
Echeverría, Alfonso
Saldivar Rodea, Carlos Alberto
author_sort Reynoso, Rafael
collection PubMed
description A significant proportion of high-flow arteriovenous malformations (AVMs) in the hand are complex to treat due to their multicentricity, size, and risk of jeopardizing distal circulation. Therefore, AVMs are frequently considered “inoperable.” We present the case of a multifocal recurrent AVM treated in conjunction with the interventional radiology department, with intra-arterial embolization and excision followed by immediate distal revascularization to replace the resulting arterial deficit. This is a case of a 24-year-old woman with a high-flow multifocal AVM in her right hand, partially excised 2 years ago, showing a pulsatile mass in the palm and dorsum of the right hand, and a reporting pain of 8 of 10 on the visual analogue scale. The procedure was performed in our hybrid operating room. This procedure lasted 4 hours, with intraoperative bleeding of 75 mL. Three weeks after the procedure, patency and good circulation of the three revascularized fingers was demonstrated using arteriography and no evidence of vascular anomalies were found. No skin loss occurred, and no reintervention was required. For radical excision of this complex high-flow recurrent AVM, detailed intraoperative documentation of its afferent and immediate embolization with gelatin-based hemostatic agents allowed its obliteration with a low reactive material. We consider that this approach might be an option to treat AVMs that are currently considered inoperable.
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spelling pubmed-104000542023-08-04 Super Selective Embolization and Immediate Resection of a High-flow Arteriovenous Malformation in the Hand Reynoso, Rafael Echeverría, Alfonso Saldivar Rodea, Carlos Alberto Plast Reconstr Surg Glob Open Hand A significant proportion of high-flow arteriovenous malformations (AVMs) in the hand are complex to treat due to their multicentricity, size, and risk of jeopardizing distal circulation. Therefore, AVMs are frequently considered “inoperable.” We present the case of a multifocal recurrent AVM treated in conjunction with the interventional radiology department, with intra-arterial embolization and excision followed by immediate distal revascularization to replace the resulting arterial deficit. This is a case of a 24-year-old woman with a high-flow multifocal AVM in her right hand, partially excised 2 years ago, showing a pulsatile mass in the palm and dorsum of the right hand, and a reporting pain of 8 of 10 on the visual analogue scale. The procedure was performed in our hybrid operating room. This procedure lasted 4 hours, with intraoperative bleeding of 75 mL. Three weeks after the procedure, patency and good circulation of the three revascularized fingers was demonstrated using arteriography and no evidence of vascular anomalies were found. No skin loss occurred, and no reintervention was required. For radical excision of this complex high-flow recurrent AVM, detailed intraoperative documentation of its afferent and immediate embolization with gelatin-based hemostatic agents allowed its obliteration with a low reactive material. We consider that this approach might be an option to treat AVMs that are currently considered inoperable. Lippincott Williams & Wilkins 2023-08-03 /pmc/articles/PMC10400054/ /pubmed/37547345 http://dx.doi.org/10.1097/GOX.0000000000005159 Text en Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Hand
Reynoso, Rafael
Echeverría, Alfonso
Saldivar Rodea, Carlos Alberto
Super Selective Embolization and Immediate Resection of a High-flow Arteriovenous Malformation in the Hand
title Super Selective Embolization and Immediate Resection of a High-flow Arteriovenous Malformation in the Hand
title_full Super Selective Embolization and Immediate Resection of a High-flow Arteriovenous Malformation in the Hand
title_fullStr Super Selective Embolization and Immediate Resection of a High-flow Arteriovenous Malformation in the Hand
title_full_unstemmed Super Selective Embolization and Immediate Resection of a High-flow Arteriovenous Malformation in the Hand
title_short Super Selective Embolization and Immediate Resection of a High-flow Arteriovenous Malformation in the Hand
title_sort super selective embolization and immediate resection of a high-flow arteriovenous malformation in the hand
topic Hand
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10400054/
https://www.ncbi.nlm.nih.gov/pubmed/37547345
http://dx.doi.org/10.1097/GOX.0000000000005159
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