Management of large high-flow arteriovenous malformations of the shoulder and upper extremity with transcatheter embolotherapy.

PURPOSE

To evaluate the efficacy of transcatheter embolization of arteriovenous malformations (AVMs) of the shoulder and upper extremity.

PATIENTS AND METHODS

Four men with large AVMs of the shoulder and upper extremity were treated with transcatheter arterial embolization. Symptoms included high cardiac output, pain, paresthesias, and disfigurement. Each patient underwent multiple sessions of embolotherapy.

RESULTS

In two patients there was no decrease in cardiac output. In three patients, no permanent decrease in AVM size or resolution of pain was achieved. Two patients experienced postembolization skin necrosis, and one experienced permanent radial neuropathy.

CONCLUSIONS

Large, high-flow AVMs in the shoulder and upper extremity may be relatively refractory to intravascular treatment because of the diffuse involvement of the soft tissues by the AVM and the lack of a well-defined nidus. Transcatheter embolotherapy in these lesions should be reserved for patients undergoing resection to help decrease intraoperative bleeding.