21/58. Early presentation of an extremity arteriovenous malformation.We report a very rare case of a high flow arteriovenous malformation (AVM) of the upper limb that caused high output cardiac failure at birth. There was early transfer of the baby to the care of a multidisciplinary team. After radiological intervention, the arm distal to the malformation became ischaemic and an urgent amputation through the upper-humerus followed. methods of treatment are discussed, together with a review of results in the literature.- - - - - - - - - - ranking = 1keywords = extremity, limb (Clic here for more details about this article) |
22/58. cardiopulmonary bypass in surgery for complex-combined vascular malformation of the lower limb: case report.A 16-year-old boy was referred with features of Parkes Weber syndrome (PWS) involving the right lower limb. He had presented at birth with cutaneous vascular malformations (VM) in the right thigh and at the age of 7 years developed congestive cardiac failure, which was controlled with drugs. He received alpha interferon and steroids during this period without any benefit. He defaulted follow-up and at 12 years of age presented with further enlargement of the VM in the right thigh and leg with skin and soft tissue thickening. At this stage, embolization and subsequent excision of the VM were tried, but the surgery was abandoned because of massive hemorrhage. Over the next 4 years, the boy became totally bedridden because of massive increase in the size of the limb, repeated hemorrhages, and secondary infection of the VM. Right hip disarticulation was considered the best option to improve his quality of life. To prevent uncontrollable hemorrhage during surgery, the disarticulation was done under cardiopulmonary bypass with low circulatory flow. Postoperatively, the patient required intensive care nursing for a week. He is presently ambulatory with crutches. cardiopulmonary bypass with low flow has been used for treating posttraumatic arteriovenous malformations. However, its use in surgery for PWS has not been reported earlier.- - - - - - - - - - ranking = 0.14062142859785keywords = limb (Clic here for more details about this article) |
23/58. A pedicle-lengthening technique for free latissimus dorsi muscle flaps: the "Y-V-I" principle.This article describes a pedicle-lengthening procedure (the Y-V-I principle) that reverts a Y-shaped vascular structure into an I-shaped vascular structure, and its application to the latissimus dorsi muscle. If the Y-shaped vascular structure is divided proximal to the branching point and ligated, it becomes a V-shaped vascular structure. To obtain a linear I-shaped vascular structure, the V is opened, and the length of the vascular pedicle will become equal to the combined length of both limbs of the V. This report indicates that the latissimus dorsi flap may be transferred based on the circumflex scapular artery or the serratus branch.- - - - - - - - - - ranking = 0.023436904766308keywords = limb (Clic here for more details about this article) |
24/58. association of Adams-Oliver syndrome with pulmonary arterio-venous malformation in the same family: a further support to the vascular hypothesis.Adams-Oliver syndrome (AOS) is a rare disease characterized by congenital scalp defects, terminal transverse limb defects and cutis marmorata telangiectatica. A significant incidence of cardiac and vascular malformations has been reported, leading to the hypothesis of a vascular defect early involved in the pathogenesis. We report two members of the same family with previously diagnosed AOS based on clinical phenotype and later recognized to have pulmonary arterio-venous malformation (PAVM). None of the subjects fulfilled current diagnostic criteria of hereditary hemorrhagic telangiectasia, which is the most common cause of PAVM. The occurrence of PAVM in AOS lends support to the hypothesis that endothelial specific abnormalities could be a patho-physiological mechanism in its development. Therefore, the role of screening for PAVM in clinical management of subjects with AOS should deserve further studies.- - - - - - - - - - ranking = 0.023436904766308keywords = limb (Clic here for more details about this article) |
25/58. Foix-Alajouanine syndrome: an uncommon cause of myelopathy from an anatomic variant circulation.Foix-Alajouanine syndrome is a rare cause of myelopathy caused by dural arteriovenous malformation of the spinal cord, mostly lower thoracic and lumbar. patients are usually over 50 years of age and can present with acute lower extremity dysesthesias or intermittent sciatica. Progression to paraplegia may be slow. Spinal angiography is needed for definitive diagnosis, based on the clues provided by the symptoms. If diagnosed early, vascular embolization or neurosurgical excision may be curative.- - - - - - - - - - ranking = 0.24414077380842keywords = extremity (Clic here for more details about this article) |
26/58. Venous angiomata: treatment with sclerosant foam.Venous angiomata, or venous malformations, are often present at birth, although they may not be evident until later. They consist of a spongy tangle of veins, and these lesions usually vary in size. Treatment of venous angiomata is often requested for cosmetic reasons, but painful ulcerations, nerve compression, functional disability can command care. This presentation describes management using sclerosant foam as the treating agent. During a 30-month period ending March 2004, 1,321 patients were investigated for venous disorders at the Vein Institute of La Jolla. Fourteen (incidence 1%) were found to have venous angiomata (: nine women). The age range was 15-76 years (mean 30.8 /- 18.6). Lesions were classified by the Hamburg system and were primarily venous, extratruncular in 12 patients and combined extratruncular and truncular in two patients. Eight patients, three males, had manifestations of lower extremity Klippel-Trenaunay (syndrome; six had only venous angiomas. Only 10 of the 14 patients were treated. All patients were studied by Doppler duplex examination. Selected lesions were chosen for helical computed tomographic studies. Magnetic resonance venography was also used to image the lesions, define the deep circulation, note connections with normal circulation, identify vessels for therapeutic access, and determine infiltration of the lesion into adjacent soft tissue. Foam was produced by the Tessari two syringes one three-way stopcock teclinique, with the air to Polidocanol ratio being 4 or 5 to 1. This was used at 1% or 2% concentration, specific for each patient. The SonoSite 190 plus Duplex Doppler was used for ultrasound guidance, whenever deep access was required and to monitor progress and effects of treatment. A goal was set for each patient before treatment was begun. Ten patients were treated, and four await treatment. The mean number of treatments was 3.6 /- 2.8 (range 1-10). A primary goal of pain-free healing was set in patients with nonhealing, painful ulceration or symptomatic varicose veins. This was achieved in all treated patients. Cosmetically, all of the patients were improved, and symptomatic patients were relieved of pain. The single complication was formation of a cutaneous ulcer following injection of telangiectasias. Sclerosant foam is a satisfactory tool to use in treating venous angiomata including the Klippel-Trenaunay syndrome. Use of foam sclerotherapy in this experience has proven the technique to be effective, essentially pain-free, and durable in the short term.- - - - - - - - - - ranking = 0.24414077380842keywords = extremity (Clic here for more details about this article) |
27/58. prenatal diagnosis and therapy of upper extremity vascular malformation causing high cardiac output and Kasabach-Merritt sequence: a report of two cases.We present two cases of upper extremity vascular malformation causing a high output state in the prenatal period. One fetus responded well to transplacental digitalis treatment. Both newborns had a Kasabach-Meritt sequence including anemia and thrombocytopenia. Postpartum treatment included successful interventional occlusion of the main feeding arteries and subsequent surgical removal of the tumor.- - - - - - - - - - ranking = 1.2207038690421keywords = extremity (Clic here for more details about this article) |
28/58. Intradural spinal arteriovenous malformation of the glomus type: a case report.Spinal arteriovenous malformations (AVMs) being even rarer than cranial ones, constitute 3 - 4% of all spinal tumours, with an overall male:female ratio of 4:1. We report the case of a 24-year old female Youth Corps member who presented with an apoplectic onset of a left hemiparesis, progressively deteriorating to an incomplete quadriplegia with motor power of 2 and 0 in the right and left lower limb muscle groups, respectively. magnetic resonance imaging (MRI) showed a vascular malformation whose precise nature was indeterminate; the definitive diagnosis of a Glomus AVM was only made intra-operatively. laminectomy with complete surgical excision was done and she gradually improved to ambulate with minimal support. The experience in our unit tends to support the observation in literature that spinal arteriovenous malformations could be very rare, and depending on the location, could be amenable to complete surgical excision and recovery of neurological function.- - - - - - - - - - ranking = 0.023436904766308keywords = limb (Clic here for more details about this article) |
29/58. Massive spouting bleeding from chronic stasis ulceration caused by arteriovenous communication of the lower extremity.We report a case of massive bleeding from a varicose vein in a calf. A 56-year-old man was brought into the emergency unit of our hospital with massive bleeding from an ulcer on his left calf. A duplex scan and arteriography revealed arteriovenous communication at the site of stasis ulceration. After primary hemostasis, coil embolization of the feeding artery to the arteriovenous communication was successfully performed, followed by stripping of the greater saphenous vein. Careful attention thus needs to be paid to arteriovenous communication that can cause life-threatening bleeding from stasis ulceration. Coil embolization of the feeding arterial branch can safely and effectively treat this disease.- - - - - - - - - - ranking = 0.97656309523369keywords = extremity (Clic here for more details about this article) |
30/58. A boy wearing two different sized slippers in his two feet.A rare case of Klippel Trenaunay Weber syndrome (KTWS) in a 13-year-old boy with lower limb asymmetry and lower motor lesion of left lower limb is presented along with a brief review of literature.- - - - - - - - - - ranking = 0.046873809532616keywords = limb (Clic here for more details about this article) |
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