AVM Flank

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Angiogram of vascular anomaly

pre operative photo

Post operative photo
It is a story of 19 year old girl who was suffering from vascular malformation .She had red colored nevus since birth. It was stable non growing as she went into teens it started troubling her . Pain , discomfort ,impairment in activity of daily life, fatigue were main complaints.Sh e went to local doctors and were investigated. Angio gram done shown to be a large Arteriovenous( AVM) malformation.It had large multiple feeders coming into anomaly from Iliac artery as shown in angiogram. Her father was searching for hospital and doctor to cure her daughter. Search in Iraq proved futile . Then they turned  to  India, and landed in Fortis Faridabad in year 2015.
I operated her in December 2015 and excised entire anomaly.  Large vessels coming out were caught and ligated. drain was also placed.Wound closure was achieve by mobilizing skin flaps . Post operative was uneventful, drain was removed on post operative day 2. Sutures were removed after one month. AVM excision wounds are notorious for poor healing. A pressure garment shaped like corset was given after one week to settle scat and dog ear.



AVM are problematic lesion. Arteries are connected to veins through abnormal vessels called nidus . In typical AVM there is no capillary bed, in this anomaly capillary bed is present. This vascular anomaly is a complex anomaly having features of capillary malformations .  AVM may be noted at birth but do not bother patient till childhood or adolescence. As capillary bed is not present blood is shunted to veins ,resulting in venous hypertension and arterialized veins .This reduces oxygen delivery to tissue which results in ischemia and ulceration . Lesions worsen over time particularly during puberty. Primary problem caused by AVM are psychological problems. They can cause pain ,bleeding ulceration . Capillary malformations are typically characterized by tissue overgrowth which was present in this anomaly. Complete or subtotal excision is the goal of surgery. Pre operative embolization can be done to reduce blood loss during surgery.




Dr Adhishwar Sharma +91 8860650846

MBBS, MS Gen Surgery PGIMER
Mch plastic Surgery
Fellowship in hand and microvascular surgery
brahmanandclinic.com
adhishwar7@gmail.com
8860650846


















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