European Journal of Plastic Surgery

, Volume 27, Issue 4, pp 204–209 | Cite as

Surgical management of a high-flow arteriovenous malformation of the upper extremity producing severe hemodynamic impairment

  • E. PolykandriotisEmail author
  • C. Böhner
  • R. Hess
  • U. Kneser
  • H. Seyhan
  • B. Loos
  • A. Bach
  • J. Kopp
  • R. E. Horch
Case Report


Peripheral arteriovenous (AV) malformations may present with a plethora of clinical symptoms such as paradoxical emboli, severe hypertension, nerve palsies or pain syndromes. Hemodynamically compromising lesions of the limbs are rare and involve high-flow AV fistulae with marked arteriovenous shunting. A female patient with a high-flow arteriovenous malformation of the left upper-extremity is presented. Preoperative assessment by magnetic resonance imaging and magnetic resonance angiography together with a color duplex investigation revealed a hemodynamically compromising arteriovenous fistula (shunt volume 30%) involving the entire left forearm and hand. The lesion was managed operatively with a combination of selective ligation and sclerosing of the feeding artery. There was marked clinical improvement postoperatively. Magnetic resonance angiography confirmed a drastic decrease in the number and size of the arteriovenous fistulae. The shunt ratio was diminished to 10%. Although surgical treatment of arteriovenous fistulae is known to have high complication and recurrence rates, thorough preoperative planning and intraoperative monitoring, can supply the prerequisites for a favorable outcome in severe symptomatic cases.


Arteriovenous fistula Hemodynamic impairment Shunt Magnetic resonance angiography 


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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • E. Polykandriotis
    • 1
    Email author
  • C. Böhner
    • 2
  • R. Hess
    • 3
  • U. Kneser
    • 1
  • H. Seyhan
    • 1
  • B. Loos
    • 1
  • A. Bach
    • 1
  • J. Kopp
    • 1
  • R. E. Horch
    • 1
  1. 1.Department of Plastic and Hand SurgeryUniversity of ErlangenErlangenGermany
  2. 2.Department of Diagnostic RadiologyFriedrich-Alexander-UniversityErlangenGermany
  3. 3.Department of Cardiology Internal Medicine IIFriedrich-Alexander-UniversityErlangenGermany

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