Reynoso Rafael, Echeverría Alfonso, Saldivar Rodea Carlos Alberto
From the Department of Plastic and Reconstructive Surgery, General Hospital of Mexico, Mexico City, Mexico.
Department of Interventional Radiology, General Hospital of Mexico, Mexico City, Mexico.
Plast Reconstr Surg Glob Open. 2023 Aug 3;11(8):e5159. doi: 10.1097/GOX.0000000000005159. eCollection 2023 Aug.
A significant proportion of high-flow arteriovenous malformations (AVMs) in the hand are complex to treat due to their multicentricity, size, and risk of jeopardizing distal circulation. Therefore, AVMs are frequently considered "inoperable." We present the case of a multifocal recurrent AVM treated in conjunction with the interventional radiology department, with intra-arterial embolization and excision followed by immediate distal revascularization to replace the resulting arterial deficit. This is a case of a 24-year-old woman with a high-flow multifocal AVM in her right hand, partially excised 2 years ago, showing a pulsatile mass in the palm and dorsum of the right hand, and a reporting pain of 8 of 10 on the visual analogue scale. The procedure was performed in our hybrid operating room. This procedure lasted 4 hours, with intraoperative bleeding of 75 mL. Three weeks after the procedure, patency and good circulation of the three revascularized fingers was demonstrated using arteriography and no evidence of vascular anomalies were found. No skin loss occurred, and no reintervention was required. For radical excision of this complex high-flow recurrent AVM, detailed intraoperative documentation of its afferent and immediate embolization with gelatin-based hemostatic agents allowed its obliteration with a low reactive material. We consider that this approach might be an option to treat AVMs that are currently considered inoperable.
手部相当一部分高流量动静脉畸形（AVM）由于其多中心性、大小以及危及远端循环的风险，治疗起来较为复杂。因此，AVM常被认为“无法手术”。我们报告一例多灶性复发性AVM的病例，该病例是与介入放射科联合治疗的，先行动脉内栓塞和切除，然后立即进行远端血管重建以弥补由此产生的动脉缺损。这是一名24岁女性，右手患有高流量多灶性AVM，2年前曾部分切除，目前右手掌和手背可见搏动性肿块，视觉模拟评分法显示疼痛评分为8分（满分10分）。手术在我们的杂交手术室进行。该手术持续了4小时，术中出血75毫升。术后三周，通过动脉造影显示三个接受血管重建的手指通畅且循环良好，未发现血管异常迹象。未发生皮肤坏死，也无需再次干预。对于这种复杂的高流量复发性AVM的根治性切除，术中对其供血情况进行详细记录，并立即用明胶类止血剂栓塞，从而能够使用低反应性材料将其闭塞。我们认为这种方法可能是治疗目前被认为无法手术的AVM的一种选择。
