MANAGEMENT OF LARGE HIGH-FLOW ARTERIOVENOUS-MALFORMATIONS OF THE SHOULDER AND UPPER EXTREMITY WITH TRANSCATHETER EMBOLOTHERAPY

PURPOSE: To evaluate the efficacy of transcatheter embolization of art eriovenous malformations (AVMs) of the shoulder and upper extremity. P ATIENTS AND METHODS: Four men with large AVMs of the shoulder and uppe r extremity were treated with transcatheter arterial embolization. Sym ptoms included high cardiac output, pain, paresthesias, and disfigurem ent, Each patient underwent multiple sessions of embolotherapy. RESULT S: In two patients there was no decrease in cardiac output. In three p atients, no permanent decrease in AVM size or resolution of pain was a chieved, Two patients experienced postembolization skin necrosis, and one experienced permanent radial neuropathy. CONCLUSIONS: Large, high- flow AVMs in the shoulder and upper extremity may be relatively refrac tory to intravascular treatment because of the diffuse involvement of the soft tissues by the AVM and the lack of a well-defined nidus, Tran scatheter embolotherapy in these lesions should be reserved for patien ts undergoing resection to help decrease intraoperative bleeding.