Peripheral Arteriovenous Malformations-A Case Series

Surgical Resection of Vascular Anomalies of the Upper Extremity-An Observational Study

Background/Objectives: This study aimed to investigate surgical resections of vascular malformations and haemangiomas of the upper extremity, pre- and postoperative symptoms, complications and recurrences. Methods: A total of 82 patients with vascular malformations and haemangiomas treated by surgical resection from 2010 to 2020 were included in this observational study. Pre- and postoperative symptoms, including pain and swelling, as well as complications and recurrence rates, were assessed. Descriptive statistics were provided for all reported data. Parametric and non-parametric tests were used for group comparisons. Alterations of reported pain were assessed. A two-sided alpha of 5% determined statistical significance. Results: A total of 88 procedures were performed in 82 patients. The most common vascular malformation was a venous malformation, followed by arterio-venous malformations. More than 50% of the patients reported pain prior to the surgery, while 14.6% of patients experienced pain postoperatively, which indicated significant improvement (p = 0.001). Minor postoperative complications occurred in 31.7% of patients. Overall, a recurrence rate of 17.1% was recorded during postoperative follow-up, mostly occurring in diffuse and infiltrating types of vascular malformations. Conclusions: Surgical resections of vascular anomalies of the upper extremity led to symptom improvement and are an important part of the multidisciplinary treatment algorithm.

Arteriovenous Malformation of the Superficial Femoral Artery: A Case Report

Peripheral arteriovenous malformations (AVMs) are rare vascular anomalies characterized by abnormal connections between arteries and veins that bypass the capillary system. This case report details a three-year-old female child who presented with an enlarging swelling on her knee's medial side. AVM was diagnosed using computed tomography (CT) angiography and surgically excised. The case highlights the importance of early detection and timely intervention of AVMs to prevent complications.

Calf arteriovenous malformation presenting as an iliac artery aneurysm: A case report

INTRODUCTION AND IMPORTANCE

Arteriovenous malformations (AVMs) are abnormal connections between arteries and veins. Common signs of AVMs include a pulsating mass, pain, ulceration, bleeding, and tissue necrosis. This case report discusses a rare presentation of an iliac artery aneurysm in a patient with an extensive calf AVM.

CASE PRESENTATION

A 35-year-old male presented with a pulsatile mass in the abdomen, along with symptoms of chronic venous insufficiency in the lower limb. He had undergone multiple surgeries for varicose veins in the past. Initially, external iliac artery aneurysm was diagnosed. Further assessment revealed the presence of an AVM in the calf. After multiple unsuccessful endovascular interventions, amputation was recommended. However, the patient opted for conservative management.

CLINICAL DISCUSSION

AVMs are vascular malformations that are present from birth. Angiography is considered the gold standard for confirming the diagnosis of AVMs. As there is no consensus on the best treatment for AVMs, a multidisciplinary approach is recommended on a case-by-case basis. Delaying treatment can lead to serious complications and increase morbidity and mortality. Treating extensive AVMs that involve the entire extremity can be particularly challenging and often result in poor outcomes.

CONCLUSION

The presence of varicose veins at a young age may indicate an underlying AVM. AVM can manifest in various ways, including arterial aneurysms. In severe cases, extensive AVMs may require limb amputation when other treatments fail.

Cliniciopathological Spectrum of Skin and Soft Tissue Swellings at a Tertiary Care Hospital of Lahore, Pakistan

Background Skin and soft tissue swellings (SSTS) frequently present in dermatology, plastic surgery, and general surgery departments. While a general surgeon can take care of excisable lesions, people typically seek plastic surgery for cosmetic reasons. According to the signs and symptoms, soft tissue and skin lesions must be removed, and it is crucial to maintain cosmesis following their removal. Objective The aim of this article is to describe the clinical and histopathological types, sites, laterality, and postoperative complications of SSTS. Material and methods This retrospective study was conducted at the Department of Plastic and Reconstructive Surgery, Lahore General Hospital, Lahore, Pakistan in November 2022. We studied admitted patients from July 1, 2020 to June 30, 2022 for SSTS excision. Data on patients' demographics, associated features of SSTS, and their postoperative complications was gathered using Google Docs-generated proforma and sent to a statistician for the computation of results via a Microsoft Excel-generated spreadsheet. Results Out of the total 60 patients, 66.7% of the lesions were found in women. The mean age at presentation came out to be 34.16±17.42 years. Nevi with 16.7% were the most common SSTS in our study. The most common site of presentation of SSTS was the scalp and face in 63.3% of cases. Fever was the most frequently encountered post-excision complication in 40% of patients. Conclusion A comprehensive history, clinical examination, signs and symptoms, and the histology of the lesion, all play a crucial role in the management of such swellings. Surgery was the definitive treatment option for SSTS. There were very few major complications in a handful of patients.

Shoulder Pain Associated With Multiple Arteriovenous Malformations Successfully Treated With Embolization

A 44-year-old male presented with left upper extremity and shoulder pain with worsening functional impairment after years of repetitive use, overtraining, and multiple injuries from weightlifting and mixed martial arts. Imaging showed no obvious injury or ligamentous deformity other than mild osteoarthritis (OA) of the left glenohumeral joint. Duplex ultrasonography (US) revealed four arteriovenous malformations (AVMs) surrounding the shoulder joint and left upper extremity. The vasculature was mapped via angiography through a transradial approach. Initial treatment included transarterial embolization of two AVMs off the axillary artery and branching anterior circumflex humeral artery. Secondary treatment included embolization of two lesions months later via direct puncture, one through a transvenous approach and the second through direct transmalformation cannulation, via the nidus, near the clavicle and posterior scapular lateral border. Treatment resulted in significant improvement in pain and range of motion. Follow-up assessments revealed improvement in overall symptoms, recovered function, and return to exercise and competitive mixed martial arts. This case highlights the value of duplex ultrasonography, embolization, and transarterial and transvenous approaches for the treatment of AVM-associated extremity or joint pain.