Major Limb Amputations in Patients with Congenital Vascular Malformations

Diagnosis of a chronic wound in the special case of a vascular malformation: A proposal of the Wound and Healing Group of the French Society of Vascular Medicine

Vascular malformations can present with a variety of symptoms and an unpredictable course with the occurrence of wounds. Ulcerations in patients with vascular malformations are fortunately rare. Although few data exist, complications may involve a variety of mechanistic or hemodynamic factors. A rigorous etiological and vascular assessment is therefore essential. In view of the paucity of recommendations, the Wound and Healing Group of the French Society of Vascular Medicine, based on the literature on the subject, presents a number of suggestions for the diagnosis and management of wounds associated with vascular malformations.

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.

Development of hemodynamically relevant acquired arterio-venous fistulae in patients with venous malformations

BACKGROUND

Venous malformations tend to retain their slow-flow behavior, even in progressive disease or regression following therapy.

OBJECTIVE

The aim of this study is to analyze the development of acquired hemodynamic relevant arterio-venous fistulae in patients with slow-flow malformations.

METHODS

This study is a retrospective analysis based on a consecutive local registry at a tertiary care Interdisciplinary Center for Vascular Anomalies. Patients with venous malformations and development of secondary arterio-venous fistulae were included. Indications for therapy of the vascular malformation were based on patients' symptoms and complications. The following endpoints were of clinical interest and were assessed: origin of development of arteriovenous fistula, development of secondary comorbidities as a result of the vascular malformation. For analysis we focused on descriptive statistics.

RESULTS

Out of 1213 consecutive patients with vascular malformations, in 6 patients perfusion changed from slow flow to arterio-venous fast-flow patterns. Four patients developed the fistula after local trauma in the area of the malformation, the other 2 patients developed the fistula due to progression of the disease and recurrent thrombophlebitis. These 2 patients had no trauma or interventions at the time of arterio-venous fistula development.

CONCLUSIONS

Acquired arterio-venous fast-flow fistula in patients with slow flow vascular malformation is very rare and might be a result of local trauma or the progression of the disease with recurrent thrombophlebitis. Specific evidence-based treatment options for these patients do not exist.