In Reply to: Re: Case 0498_11 -- Management of massive pelvic AVM posted by Keith Shonnard on April 08, 1998 at 01:42:36:
We have a patient with a massive thoracic AVM that we've kept alive and functional for >10 years by repeated alcohol and other ablations. She has recently come back with heart failure and recruitment of many additional feeders. The main blood supply comes from the subclavian artery. I do not think that one can completely obliterate huge AVMs and it is a matter of time before one has to reintervene. What we have to offer is however effective and less risky compared to surgical options. One has to be very patient, map out precisely the lesion with MRI and angio and go after it aggressively over a few sessions. Going after the nidus is the key. Either puncturing it directly or getting very close to it with microcatheters and using dehydrated alcohol are essential. One has to treat these lesions under general anaesthesia and have a very good rapport with the patient and their family. The potential harm is great (limb loss, death) but the potential benefit is also great if the lesion is treated appropriately.