CASE REPORT Upper-Limb Disarticulation for Life-Threatening High-Flow Arteriovenous Malformation: Report of a Case.
Year: 2010
Type: article
Study design: Case Report
Abstract: Arteriovenous malformations (AVM) are high-flow lesions having a direct connection between an artery and vein, with bypass of the capillary bed. 1 Those affecting the upper limb and causing cardiac decompensation are rare. Treatment of such lesions remains a surgical challenge. Despite multiple procedures, total eradication is often not achieved. For some patients, limb amputation becomes necessary and carries significant risk. We report a case of congenital AVM of the upper limb causing cardiac decompensation. The patient was safely and successfully treated by performing a 2-stage upper-limb amputation. CASE REPORT A 32-year-old man presented with a congenital high-flow AVM involving the left upper limb and anterior chest (Fig 1). In recent years, the AVM had undergone rapid expansion causing the patient significant pain, high-output cardiac failure, and dyspnea on minimal exertion. The pain was resolved by elevation of the arm. In addition, there was a chronically infected wound on the dorsum of the left hand from which he suffered a massive bleed 6 years previously. On that occasion, he lost 3500 mL of blood. Amputation of the digits through the metacarpophalangeal joints had been previously performed at another hospital. At presentation, the left upper limb was warm and hypertrophic with pulsating vessels. Bruits were audible and a thrill palpable over the axillary artery. A dry eschar covered the chronic wound on the dorsum of the hand. The vascular malformation over the anterior chest manifested as an uncomplicated reddened patch.
Source: PubMed Central
Authors: Yi-Hsuan Su, Vasu Karri, Lai-Fan Lu, Hung-Chi Chen
Institutions: E-Da Hospital, I-Shou University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1482499325