Successful Upper Limb Salvage After Aneurysm Rupture Due to Congenital Arteriovenous Malformation

Abstract

This is a unique case of aneurysmorrhaphy and vascular isolation for an aneurysm rupture due to congenital arteriovenous malformation (AVM) of the upper extremity in that a surgical approach could be performed at the site of hematoma to allow successful ligation of arterial inflow and outflow. A 71-year-old woman, having been diagnosed as having AVM 20 years previously, visited the hospital with a chief complaint of progressive swelling of her left forearm with severe pain. Selective angiography showed aneurysmal dilatation and tortuosity of the arterial trunk with preserved anatomical structures in the left upper limb, as well as numerous arteriovenous fistuiae. The proximal portion of the radial artery had enlarged to 5 cm in diameter, forming an aneurysm. The angiogram also showed extravasation of contrast material from the aneurysm, indicating its rupture. At first, the patient was treated conservatively with external compression, since surgical management was considered to carry an unacceptably high risk of limb amputation due to uncontrollable hemorrhage. However, during hospitalization, the swelling worsened to such an extent that there was the possibility of bleeding from the skin. Therefore, a palliative surgical procedure was undertaken for symptom relief. Precise preoperative information from several diagnostic devices permitted performance of this surgery though a minimally invasive route to the aneurysm without any postoperative complications.