Giant Chest Wall Arteriovenous Malformation: A Case Report and Literature Review
| Autor: | Joshua L. Gierman, Suhair Maqusi, Subrato J. Deb, Cullen K. McCarthy |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Computed Tomography Angiography medicine.medical_treatment Subclavian Artery 030204 cardiovascular system & hematology Asymptomatic Coracoid Arteriovenous Malformations 03 medical and health sciences 0302 clinical medicine medicine Humans Embolization Mammary Arteries Thoracic Wall Computed tomography angiography medicine.diagnostic_test business.industry Angiography Digital Subtraction Stent Arteriovenous malformation Skin Transplantation General Medicine Middle Aged medicine.disease Embolization Therapeutic Surgery Treatment Outcome medicine.anatomical_structure Clavicle 030220 oncology & carcinogenesis Carotid Artery External Angiography Radiology medicine.symptom Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures |
| Zdroj: | Annals of Vascular Surgery. 46:369.e7-369.e11 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2017.08.028 |
| Popis: | Background We present an interesting case of a 55-year-old male with a large left chest mass after significant cutaneous bleeding. Computed tomography angiogram of the chest revealed arteriovenous malformation with blood supply from sub-branches of the left subclavian artery, left internal mammary artery, and left external carotid artery. Measuring 5.0 × 14.0 × 10.8 cm, the mass extended superior to the clavicle and inferior to the third rib with medial and lateral borders at the level of the clavicular head and coracoid, respectively. Methods Arteriovenous malformations (AVMs) are characterized by abnormal connections between arteries and veins which bypass the capillary system. Often small and asymptomatic, large AVMs can be painful, prone to bleeding and, if large enough, interfere with activities of daily living. While described involving various parts of the body, most notably in the central nervous system, there is a paucity of literature involving chest wall AVMs. Results Using a staged, multidisciplinary approach, treatment began with an endovascular exclusion of the arterial blood supply, which involved a combination of coil embolization and stent exclusion of feeder vessels. Two days postembolization, the patient underwent an en bloc resection of affected portion of his chest wall. Reconstruction was completed with a combination rotational flap and split-thickness skin graft. Following the procedures, the patient had an uncomplicated recovery. Three years following procedure, he has no signs of recurrence of his AV malformation. Conclusion Surgical planning and indications for giant arteriovenous malformations remains a unique and difficult problem. The complex anatomy and extreme rarity of a chest wall AVM requires a multidisciplinary staged approach but can be treated with a multistage, multidisciplinary surgical approach with satisfactory and long-lasting results. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|