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

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Abstract

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.

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Authors and Affiliations

  1. Department of Plastic and Hand Surgery, University of Erlangen, Krankenhausstrasse 12, 91054 , Erlangen, Germany

    E. Polykandriotis, U. Kneser, H. Seyhan, B. Loos, A. Bach, J. Kopp & R. E. Horch

  2. Department of Diagnostic Radiology, Friedrich-Alexander-University, Erlangen, Germany

    C. Böhner

  3. Department of Cardiology Internal Medicine II, Friedrich-Alexander-University, Erlangen, Germany

    R. Hess

Authors
  1. E. Polykandriotis
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  2. C. Böhner
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  3. R. Hess
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  4. U. Kneser
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  5. H. Seyhan
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  6. B. Loos
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  7. A. Bach
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  8. J. Kopp
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  9. R. E. Horch
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Correspondence to E. Polykandriotis.

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Polykandriotis, E., Böhner, C., Hess, R. et al. Surgical management of a high-flow arteriovenous malformation of the upper extremity producing severe hemodynamic impairment. Eur J Plast Surg 27, 204–209 (2004). https://doi.org/10.1007/s00238-004-0654-6

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  • DOI: https://doi.org/10.1007/s00238-004-0654-6

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