Percutaneous Treatment of Life-Threatening Congenital Arteriovenous Malformations with the Wallgraft Endoprosthesis

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Abstract
Purpose: To report the percutaneous endovascular repair of massive congenital arteriovenous malformations (AVMs) of the right arm complicated by tissue ischemia, severe edema, and life-threatening recurrent hemorrhagic episodes. Methods and Results: A 25-year-old man with a 3-year history of symptomatic upper right arm AVMs had been treated unsuccessfully with surgical ligation and coil embolization. The arm had become massively enlarged, disfigured, severely painful, and unusable, with extension of swelling to the upper chest. Under compassionate use as part of an investigational protocol, the AVMs were closed with 6 overlapping Wallgraft endoluminal prostheses deployed in the right brachial, axillary, and subclavian arteries, preserving the vertebral and distal circulations. Unfortunately, the patient suffered numerous pulmonary emboli and died 2 days after the procedure. Conclusions: Percutaneous treatment of massive AVMs appears feasible with the Wallgraft endoprosthesis, but optimal postprocedural management of such large anomalies should include immediate venous filter placement and aggressive anticoagulation therapy with intravenous heparin.