안면부에 발생한 동정맥루의 치험례

최수종,오흥찬,배용찬,남수봉,문재술,오창근,김창원 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.3

Purpose: Arteriovenous fistula is one of high flow vascular malformations. Recently, arteriovenous fistula has been regarded as one of the type of arteriovenous malformations. The patients were diagnosed as arteriovenous malformation Schobinger clinical stage II. Even though arteriovenous fistula rarely occurs on head and neck, treatment of that is difficult due to frequent recurrence. In treating the arteriovenous fistula, chemical embolization, surgical excision and other treatment modalities were used, but the results were not satisfactory. The authors experienced three cases of arteriovenous fistula and treated them with surgical excision.Methods: In cases, warmth, enlargement, pulsation, thrill, and bruit were found. For the accurate evaluation before the operation, angiography and MRI were checked in advance. Incision was made on the site of pulsation. The artery and vein connected to the arteriovenous fistula were dissected widely, individually ligated, and divided. And then the entire mass was totally removed.Results: All surgical sites were healed well without complications and there was no evidence of recurrence in all cases up to for 2 years of follow-up examination.Conclusion: The arteriovenous fistula on face is a very rare disease and has difficulties in treatment. The authors experienced three cases of arteriovenous fistula with complete surgical removal and no recurrence was found in all cases.

The management of mandibular arteriovenous malformation using the surgical therary with preoperative embolization

장도근(Do Geun Jang),최강영(Kang Young Choi),김진수(Chin Soo Kim) 대한구강악안면외과학회 1995 대한구강악안면외과학회지 Vol.21 No.4

구강악안면영역의 혈관질환은 매우 위험한 질환으로 술자에게 주의를 요한다. 여기에는 혈관종과 혈관기형이 있으며 정확한 기왕력과 적절한 임상검사로 감별진단이 가능하지만 진단적인 혈관조영술이 요구되기도 한다. 치료에는 경화술, 냉동술, 방사선치료, 결찰술, 혈관색전술, 레이저치료 및 외과적 접근법이 있다. 특히 동정맥기형에서의 외과적 접근법에는 많은 논란이 있는데, 병소의 경계를 포함한 완전한 제거가 요구된다는 의견과 단순한 소파술만으로 치료가 가능하다는 상반된 경우가 있다. 본 증례는 Gelfoam을 이용하여 술전 혈관색전술 시행한 후 건전한 협측 피질골을 거상, 내부 종물의 소파술을 시행한 후 거상한 피질골을 재위치시킴으로서 악골의 외형을 잘 보존한 경우로 술후 기능적 및 심미적으로 양호한 결과를 얻었기에 보고합니다. Vascular lesions of the oral and maxillofacial region are as challenging to clinicians as they are devastating to patients. Two basic entities of hemangioma and vascular malformations exist as vascular lesions. The differential diagnosis bfetween these two lesions can be done through the history and the phyisical findings. Some lesions may be difficult to evaluate; therefore, a diagnostic angiography may be employed. Management of maxillofacial vascular malformations consists of sclerotherapy, cryotherapy, radiotherapy, intralesional ligation, embolotherapy, laser therapy, and surgical treatment. The surgical management of vascular malformations, particularly the arteriovenous malformation, remains as controversial an issue as any in contemporary oral and maxillofacial surgery. On one hand, there is a surgically aggressive school of thought that advocates major segmental or en bloc resecton of the arteriovenous malformation. The opposite point of view is clearly reflected by the numerous case reports that appear in the literature of arteriovenous malformations managed by simple curettage. We experienced a large mandibular arteriovenous malformation with an intact buccal cortex that was treated with curettage with the lateral decortication and reposition of the decorticated buccal bone plate after preoperative embolization using Gelfoam and without arbitrary sacrifice of the uninvolved cortical margin that could provide stability of the mandibular arch. The postoperative result was good aesthetically and functionally.

비첨부에 발생한 동정맥 기형 1예

노양섭,류광희,김효열 대한이비인후과학회 2020 대한이비인후과학회지 두경부외과학 Vol.63 No.3

Arteriovenous malformation is a vascular malformation with fast-flow shunt from the arteryto the vein. Extracranial arteriovenous malformation in the head and neck area is rare diseasecompared to other vascular malformations such as venous malformation or lymphatic malformation. Extracranial arteriovenous malformations especially on face can cause aesthetic problems,therefore surgeons should consider an importance of cosmetic outcome and choose appropriatetreatment plan. We report a case of 51-year-old male who presented with enlargednasal tip diagnosed arteriovenous malformation. This case showed successful outcome aftercombination therapy consisted of superselective embolization and surgical resection.

안면부 동정맥기형의 수술적 처치와 재건

김석권,김정태 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.3

Arteriovenous malfomation poses an unsolved, uncontrollable surgical challenge. Many therapeutic modalities have been introduced, but the great recurrence of the malformation after the radical resection should not be ignored. The altered hemodynamic conditions and newly formed ischemic areas after the surgical resection can accelerate the dormant artervenous shunt and stimulate the expansion of regional collaterals. So, the appropriate reconstruction method must be considered to prevent its recurrence. We have our own therapeutic principles; preoperative selective embolization, radical resection with saving the important structures, and well-vascularized tissue reconstruction such as island or free flap. 5 patients with facial arteriovenous malformations(2 on the temple, 2 on the auricle, 1 on the cheek), were treated with this modality and this concept can be expected to provide great remission of arteriovenous malformation. Free flap transfers were used in 3 cases. The feeding vessels of the arteriovenous malformation were used as recipient vessels of free flap, and so such hemodynamic redistribution of flow also limited the development of new arteriovenous shunts in ischemic field of resection.

하지 외상 후 진단된 Arteriovenous Malformation의 치료

김성엽 ( Seong Yup Kim ),진성찬 ( Sung Chan Jin ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.4

Congenital arteriovenous malformation is rare disease. Endovascular treatment is one of the important modality in the treatment of arteriovenous malformation. We report a successful treatment case of arteriovenous malformation with endovascular treatment.

간세포암의 경동맥 화학색전술 중 발견된 후천성 동정맥 기형에 관한 드문 증례보고

문성남(Sung-Nam Moon),서상현(Sang-Hyun Seo) 한국산학기술학회 2019 한국산학기술학회논문지 Vol.20 No.3

경동맥 화학색전술은 널리 이용되며 빠르게 발전하고 있는 간세포암의 비수술적 치료법이다. 만족할만한 치료결과를 얻기 위해서는 환자의 해부학적 특성을 이해하고 종양공급 동맥을 찾아내서 올바른 치료 계획을 세워야 한다. 본 연구에서는 간세포암의 경동맥 화학색전술 중에 방해요인으로 작용한 후천성 동정맥기형의 증례를 보고하고자 한다. 72세 남자가 2일전부터 지속된 복통으로 내원하였다. 만성 B형 간염환자로 10년 전 간세포암에 대한 고식적 경동맥 화학색전술을 시행 받고 완치된 과거력이 있었다. 전산화 단층 촬영상 간우엽의 8분절에 결절성 간세포암이 발견되었으며 우간동맥은 상장간막동맥에서 기시하는 기형을 가지고 있었으며 종양 주변에 과혈관성 종양 구조가 관찰되었다. 1차 경동맥 화학색전술을 실시하였을 때 좌간동맥에서 기시하는 종양 공급동맥을 찾아 이를 약물방출미세구와 Adriamycin 50mg을 이용하여 화학색전하였다. 우간동맥조영술을 시행하였을 때 동정맥 기형이 관찰되었으며 간세포암은 관찰되지 않았다. 1개월 후시행한 전산화 단층 촬영상 괴사된 종양과 남은 병변이 관찰되어 2차 경동맥화학색전술을 시행하였다. 우간동맥을 통하여 미세유도철사와 카테터를 이용하여 동정맥 기형을 지나쳐 초선택하였고 시행한 조영술에서 남은 간세포암의 병변이 조영됨을 확인할 수 있었다. 이를 약물방출미세구와 Adriamycin을 이용하여 화학색전하였다. 시술 후 혈관 조영술에서 간세포암이 조영되지 않는 것을 확인하였고, 그 후 환자는 특별한 합병증 없이 퇴원하였다. 저자들은 매우 드물게 발생하는 간세포암 주변의 후천성동정맥기형을 발견하였고, 방해요인으로 작용한 동정맥 기형을 넘어 초선택적 경동맥화학색전술을 시행하여 간세포암을 치료하였다. Transarterial chemoembolization (TACE) is a commonly used and rapidly evolving non-invasive treatment for hepatocellular carcinoma (HCC). It is important that understanding individual anatomical variants and planning for tumor-feeding artery access to acquire adequate treatment effectiveness. In this study, we will report acquired arteriovenous malformation which interferes with TACE for HCC. A 72-year-old man with persistent abdominal pain for 2 days visited our hospital. The patient was chronic hepatitis B carrier and had a history of HCC treated with conventional TACE 10 years ago. Hypervascular nodular HCC in the liver segment 8 and aberrant right hepatic artery from the superior mesenteric artery were detected on computed tomography (CT). When first TACE was performed, the tumor-feeding artery originating from the left hepatic artery was found and embolized. There was no tumor-feeding artery from the right hepatic artery but arteriovenous malformation was found. After a month, follow up CT showed necrotic lesion and residual HCC and we performed secondary TACE. On secondary TACE, we selected the right hepatic artery and passed through arteriovenous malformation. Superselective-angiogram showed remnant tumoral staining and remnant tumor was embolized using drug-eluting bead and Adriamycin. Final angiogram showed no remnant tumoral staining and the patient was discharged without complication. We found the rare case of arteriovenous malformation adjacent to HCC, and we performed superselective TACE beyond arteriovenous malformation to treat HCC.

Clinical and anatomic description of patients with arteriovenous malformation treated with endovascular therapy in a Mexican population

Mallyolo Eliezer Pelayo-Salazar,Héctor Alfredo Montenegro-Rosales,Jorge Luis Balderrama-Bañares,Pablo Martínez-Arellano,Omar Andrés Campos-Flota,Laura Mestre-Orozco,Julio César López-Valdés 대한뇌혈관외과학회 2023 Journal of Cerebrovascular and Endovascular Neuros Vol.25 No.1

Objective: Arteriovenous malformations (AVMs) are benign congenital lesions. The estimated prevalence is 10-18 per 100,000 individuals, with an incidence rate of 1.1-1.4 per 100,000 person-year; only 12% of AVMs present symptoms during life. It is important to study different characteristics associated with AVMs because these patients require multidisciplinary treatment. Methods: A descriptive, observational, longitudinal, and retrospective study was carried out from January 15, 2016 to October 19, 2021. Convenience sampling was used on patients diagnosed with arteriovenous malformation. Sociodemographic data was obtained, such as: sex, age, site, predominant symptoms, clinical debut, type of malformation, data associated with post therapy evolution, type of embolizing agent used, associated complications, Rankin scale, and death. Results: Data from 535 procedures was collected, we calculated an incidence of 4.4 cases per million inhabitants. Ninety procedures in 56 patients that used endovascular therapy were obtained with a female-male ratio of 0.75 and an age distribution of 35±14 (SD). A 36.3±11.5 (SD) mm diameter was registered. There was a 33% success rate for endovascular surgery. Conclusions: The multidisciplinary treatment of AVMs is made up of three pillar techniques: microsurgical resection, embolization, and radio-neurosurgery. It is extremely important to make an appropriate decision, with an emphasis on achieving better functional outcomes for the patient. Although neurological endovascular therapy was initially used as an adjuvant treatment for neurosurgery and radio-neurosurgery, it has been used more and more frequently as the first line of treatment.

경피 경정맥 간내 문맥전신성 단락술로 치료한 췌장의 동정맥 기형에 의한 간문맥 고혈압

현동우 ( Dong Woo Hyun ),박수영 ( Soo Young Park ),박진형 ( Jin Hyung Park ),박창근 ( Chang Kun Park ),윤영미 ( Young Mi Yun ),조창민 ( Chang Min Jo ),탁원영 ( Won Young Tak ),권영오 ( Young Oh Kweon ),김성국 ( Sung Kook Kim ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.6

Pancreatic arteriovenous malformation is very rare. However, it silently progresses and frequently brings about serious condition such as portal hypertension. The removal of pancreatic arteriovenous malformation is difficult once portal hypertension has developed. Surgery is the definitive treatment of choice, but it carries high risks when the patient`s condition is poor. The transjugular intrahepatic portosystemic shunt (TIPS) is a well-accepted procedure for the treatment of intractable portal hypertension. We experienced a case in which TIPS was used for the treatment of intractable portal hypertension caused by pancreatic arteriovenous malformation. The patient suffered from ascites and intractable gastrointestinal bleeding. The portal hypertension caused by pancreatic arteriovenous malformation was diagnosed by color Doppler ultrasonography, computed tomography (CT), and angiography. TIPS might be another treatment of choice for this rare disease, when the patient`s condition is too risky for surgical treatment. (Korean J Gastroenterol 2003;41:514-518)

국소피판술을 이용한 두경부 동정맥기형의 재건 증례

윤민지(Min Ji Yun),은석찬(Seok-Chan Eun),허찬영(Chan-Yeong Heo),장학(Hak Chang),백롱민(Rong-Min Baek) 대한두개저학회 2010 대한두개저학회지 Vol.5 No.2

Arteriovenous malformation is one of high flow vascular malformations. A 15-year-old-man presented with an inflamed temporoparietal scalp arteriovenous malformation after series of embolization. The lesion was dissected widely on subgaleal layer, individually ligated, and divided. And then the entire mass was totally removed and reconstructed with scalp rotation flap. We report a case of arteriovenous malformation with complete surgical removal and aesthetical reconstruction.

안면부 동정맥 기형의 수술적 제거 후 흉배동맥 천공지유리피판을 이용한 결손의 재건

박범진,임소영,변재경,문구현,방사익,오갑성 대한두개안면성형외과학회 2009 Archives of Craniofacial Surgery Vol.10 No.1

Purpose: The treatment of arteriovenous malformation (AVM) of the face remains a difficult challenge in plastic surgery. Incomplete resection resulting in uncontrolled bleeding, postoperative enlargement of the remaining malformation, and a poor functional and cosmetic result could be the problems confronted by the surgeons. Methods: A 37 year-old male with large arteriovenous malformation in face treated with preoperative superselective transarterial embolization and free flap transfer. The size of the defect was 13 × 9 cm. Sclerotheraphy without resection were performed several times but the results were unsatisfactory. Resection was performed the next day of embolization. We were able to repair with the thoracodorsal artery perforator free flap. And facial muscle reconstruction performed by simultaneous muscle and nerve transfer. Results: During the follow-up period 8 months the patient regained an acceptable cosmetic appearance. And he has shown no reexpansion of the malformation. Conclusion: The thoracodorsal artery perforator free flap could be a good choice for the reconstruction for massive defects of the face. A huge arteriovenous malformation could be safely removed and successfully reconstructed by the complete embolization, wide excision and coverage with a well vascularized tissue.