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Abstract
Arteriovenous malformations (AVMs) are characterized by the presence of abnormal connections between feeding arteries and draining veins. It is generally assumed that symptomatic lesions can preferably be treated. Due to high arterial blood flow, there is a risk of bleeding with surgical excision alone, which can be massive and life threatening during the operation. According to recent advances in interventional technique, a hybrid approach using embolization of the feeding artery with subsequent immediate excision of the AVM for successful management of vascular lesions could be applied to AVMs. Herein, we describe a case of successful excision of AVM in the left soleus muscle using a hybrid approach.
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Figure 1.
Radiologic findings of arteriovenous malformation in the soleus muscle. (A, B) Axial and coronal T1-weighted magnetic resonance (MR) image shows iso-intense lesion in medial aspect of soleus muscle in left lower extremity. (C, D) T2-weighted MR image shows bright, highly intense, and round shaped lesion with dimentions of 1.6×1.6×2.7 cm. (E) Angiogram of left lower extremity arteries; digital subtraction angiography shows about 4 cm sized vascular malformation feed from left posterior tibial artery. (F) Post-embolization arteriogram; feeding artery was successfully embolized with gelfoam and microcoil.
Figure 2.
Macro- and microscopic findings of arteriovenous malformation in the soleus muscle. (A) Arrow indicates embolized feeding artery which is arized from posterior tibial artery. (B) The cut section of resected specimen reveals mixed fibrofatty tissue and muscle containing several medium-sized blood vessels. (C) At the low power view, a mixture of varying sized vessels, fatty tissue, and muscular tissue is noted (H&E stain, ×12.5). (D) A thick walled vessel with embolization material is noted on the upper portion (arrow), and area of mixed fatty and muscular tissue is seen on the center (H&E stain, ×40). (E) Some vessel has fibrously thickend wall with osseous metaplasia (H&E stain, ×100). (F) Artery (arrow) and dilated vascular channel (asterisk) are connected within the muscle bundles. Factor-VIII highlights endothelial cells in both artery and vascular channel (Factor-VIII stain, ×100)
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