Congenital subclavian artery-to-subclavian vein fistula in an adult: treatment with transcatheter embolization

Fistula from Congenital Subclavian Artery to Azygos Vein with Congestive Heart Failure in an Adult

Congenital arteriovenous communications arising from subclavian artery are very rare. We report the first case of multiple congenital arteriovenous fistulas between the right subclavian artery and azygos vein presenting with congestive heart failure.

Successful surgical resection of giant arteriovenous malformation in supraclavicular fossa

A 42-year-old woman with a large congenital giant arteriovenous malformation in the left supraclavicular fossa underwent surgical resection. Although endovascular treatment was initially planned, it was impossible to occlude the multiple feeding arteries (transverse cervical, clavicular branch of left internal mammary, thoracoacromial, anterior/posterior circumflex humeral), and the anatomy was difficult. After removal of the left clavicle, the arteriovenous malformation was exposed. Care was taken to not injure the brachial plexus, and each feeding artery was ligated, followed by division of the drainage veins. The postoperative course was uneventful, and no sign of recurrence has been seen.

Endovascular management of an arteriovenous malformation using an occluder stent graft

A 58-year-old woman presented with gangrene of the left upper arm stump caused by an arteriovenous malformation originating from the subclavian artery. She had been treated unsuccessfully in the past with repeated attempts of coil embolization and débridement, but finally she underwent arm amputation. A 14 mm diameter occlusion self-expandable stent was placed in the left subclavian artery via ipsilateral brachial artery access, with immediate and complete interruption of arterial supply to the vascular malformation. This minimally invasive treatment provides an alternative method of management of arteriovenous malformations in the subclavian region.