title: Treatment of a massive left femoral arteriovenous malformation using an innovative modular hybrid bifurcated stent graft system.
abstract: BACKGROUND
  Arteriovenous malformations (AVMs) are difficult to treat and manage because of their high recurrence and complication rates. In particular, peripheral AVMs pose multiple clinical challenges because of their high flow rates and the frequent presence of multifocal nidi.
  
  
  METHODS
  A 37-year-old man with a massive AVM involving the left common, deep, and superficial femoral arteries and veins is discussed herein. After initially being treated at another facility with coil embolization in 2005, he went untreated until he presented to us in April 2012 with swelling, tissue breakdown, leg ulcers, pain, and difficulty walking. When our extensive packed coil embolization proved ineffective, we knew that other standard treatments would be impractical, given the size of the AVM. Because the patient was in significant danger of bleeding, we treated him endovascularly with a system of modified stent grafts to exclude the arterial branches feeding multiple nidi.
  
  
  RESULTS
  Postoperative computed tomography angiography scans revealed exclusion of the AVM and excellent flow to the deep and superficial femoral arteries. At 6 months postoperatively, the patient had no complications, and the leg continued to decompress. At 8 months postoperatively, we started additional treatment using percutaneous sclerotherapy to treat residual areas.
  
  
  CONCLUSIONS
  A modular hybrid bifurcated stent graft system is a viable option to treat or manage complex peripheral arteriovenous malformations.
authors.affiliation: Sanford Research/USD, Sioux Falls, South Dakota.
authors.forename: Laura
authors.initials: L
authors.lastname: Danielson
authors.affiliation: Sanford Research/USD, Sioux Falls, South Dakota.
authors.forename: Joseph
authors.initials: J
authors.lastname: Anderson
authors.affiliation: Sanford Research/USD, Sioux Falls, South Dakota.
authors.forename: Madeline
authors.initials: M
authors.lastname: Nykamp
authors.affiliation: Sanford Research/USD, Sioux Falls, South Dakota.
authors.forename: Tyler
authors.initials: T
authors.lastname: Remund
authors.affiliation: Sanford Health, Sioux Falls, South Dakota. Electronic address: Patrick.kelly@sanfordhealth.org.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kelly
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures / Q000295:instrumentation*; D005263:Femoral Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005268:Femoral Vein / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011474:Prosthesis Design; D012039:Regional Blood Flow; D015911:Sclerotherapy; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors