The first recorded case of an arteriovenous malformation was in the late 16th century. In 1757, William Hunter described an arteriovenous malformation as an abnormal communication between an artery and a vein. Arteriovenous malformations can occur anywhere in the body. They frequently occur as isolated, stable anomalies requiring no specific treatment. Some AVMs may be extensive, multiple, recurrent and progressive causing disfigurement with the potential for life-threatening haemorrhage, thrombosis, painful ischemia or high-output congestive heart failure. These occurrences usually are indications for intervention, which is often technically difficult and unrewarding .Surgery in deep hypothermic circulatory arrest has a role in this failed intervention.

A 19 year old boy was referred to us with a diagnosis of recurrent and large arteriovenous malformation over the right side of the chest below the clavicle. He underwent embolization of the feeding vessels in 2002, 2003 & 2005 with absolute alcohol, gel foam and metallic coils respectively. He also underwent radiotherapy with cobalt fractions in 2006. In spite of multiple embolization and radiotherapy the lesion was progressively increasing along with symptoms of severe pain in the hand and increase in the severity of breathlessness associated with moderate cardiomegaly. On examination swelling measured 8x10 cm on the right sub clavicular area which is compressible and associated with a thrill. He had small arteriovenous malformation in the right palm and in the back near the right scapula for which excision of the swellings was done in 2003. Biopsy specimen showed multiple arterio venous malformation. Recurrence of the arteriovenous malformation, severe pain in the hand and failed interventions made us to proceed to surgery.

Chest x-ray showed moderate cardiomegaly, scoliosis with embolization coils [Figure 1].Computed tomographic angiogram showed large arteriovenous malformation with arterial feeders from the right sub clavian artery, branches of both internal mammary artery ,upper and middle right intercostal arteries, both external carotid artery through the superior thyroid artery. The venous drainage of the sac was through the right sub clavian, right brachiocephalic and right internal jugular vein. The brachiocephalic and internal jugular vein was stenosed at their origin from the sac. Echocardiogram showed good ventricular function with enlarged right atrium and ventricle. Electrocardiogram was normal sinus rhythm, right axis deviation with right ventricular hypertrophy. The blood investigations were found to be normal. After a thorough evaluation and discussion with the radiologist and the plastic surgeons, the patient was planned for surgery under cardiopulmonary bypass.

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ISSN: 2155-9880

Current Issue: Volume 11, Issue 6

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