asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2023-019asurgery-407Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCE | PRACTICEКлинический случай успешного хирургического лечения артериовенозной мальформации в области 1-го пальца кистиClinical case of successful surgical treatment of arteriovenous malformation of the thumb fingerhttps://orcid.org/0000-0003-0258-1155РахимовА. Р.RakhimovA. R.

Рахимов Амриддин Равшанович, сердечно-сосудистый хирург 

109028, Москва, Покровский бульвар, д. 8, стр. 1

Amriddin R. Rakhimov, Cardio-Vascular Surgeon 

8, Bldg. 1, Pokrovsky Ave., Moscow, 109028

erkin-rakhimov@yandex.ruhttps://orcid.org/0000-0002-1052-2393РомановД. В.RomanovD. V.

Романов Дмитрий Вячеславович, детский хирург 

109028, Москва, Покровский бульвар, д. 8, стр. 1

Dmitriy V. Romanov, Pediatric Surgeon 

8, Bldg. 1, Pokrovsky Ave., Moscow, 109028

farabef@yandex.ruhttps://orcid.org/0000-0002-3855-7440КаревМ. А.KarevM. A.

Карев Максим Анатольевич, врач-хирург 

109028, Москва, Покровский бульвар, д. 8, стр. 1

Maksim A. Karev, Surgeon 

8, Bldg. 1, Pokrovsky Ave., Moscow, 109028

maxim.karev75@yandex.ruЦентр сосудистой патологииРоссияCentre of Vascular PathologyRussian Federation202330112023202258263Copyright © Рахимов А.Р., Романов Д.В., Карев М.А., 20232023Рахимов А.Р., Романов Д.В., Карев М.А.Rakhimov A.R., Romanov D.V., Karev M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/407

Лечение артериовенозных мальформаций, локализующихся в области кисти, представляет собой одну из самых сложных проблем в сосудистой хирургии. В первую очередь это связано с особенностями кисти – вовлеченности в патологический процесс сосудов и нервов, расположенных на ограниченном анатомическом пространстве. Диагностический комплекс кистевых артериовенозных мальформаций включает в себя: клинический осмотр, ультразвуковое исследование с цветовым допплеровским картированием, магнитно-резонансную томографию с внутривенным контрастированием, ангиографию и термографию. Существуют различные методы хирургического лечения пациентов с АВМ в области кисти: эндоваскулярные и открытое оперативное вмешательство. Эндоваскулярные способы, такие как эмболизация и склерозирование, сопряжены с риском развития грозных осложнений: некроза мягких тканей, тромбоза дистального сосудистого русла, нарушения чувствительной и двигательной функции кисти. Не всегда малоинвазивные методы лечения способствуют получению адекватного клинического результата. В статье приведен пример успешного хирургического лечения пациентки с артериовенозной мальформацией 1-го пальца кисти, у которой отмечался выраженный болевой синдром, периодически кровоточащие язвы. Под артериальным жгутом было выполнено радикальное удаление мальформации с сохранением артериального кровоснабжения. На контрольном осмотре через 1 год у пациентки отмечается отсутствие болевого синдрома и язв, восстановление подвижности в межфаланговом и пястно-фаланговом суставах. Таким образом, при лечении артериовенозных мальформаций в области кисти необходимо основываться на мультимодальном диагностическом обследовании, включающем в себя привычные и современные инструментальные методы. Данный клинический пример иллюстрирует, что открытое хирургическое вмешательство при удалении артериовенозной мальформации на кисти является безопасным и эффективным методом лечения с хорошим среднесрочным результатом.

The management of arteriovenous malformations of the hand is one of the most difficult problems in vascular surgery. It’s primarily related to the number of vessels and nerves involved in the pathological process on a very limited anatomical area. Commonly the required steps of the diagnostic process are the following: clinical examination, Doppler colour flow mapping, MRI with intravenous contrast, angiography and thermography. There are various methods ofsurgical treatment of patients with arteriovenous malformation of the hand. Generally, they might be classified as endovascular and open-surgical ones. Endovascular methods, such as embolization and sclerotherapy, are associated with the risk of severe complications such as soft tissue necrosis, distal vascular bed-specific thrombosis, along with both sensory and motor connectivity of the hand. However minimally invasive procedures do not always contribute to an appropriate clinical result. This article presents an example of successful surgical treatment of a patient with arterio-venous malformation of the thumb finger with severe pain syndrome and recurrent bleeding ulcers. A radical removal of the malformation-bearing tissue with preservation of the arterial blood supply was performed under an arterial tourniquet. At the one-year post-surgery follow-up examination, the patient noted the absence of pain syndrome and ulcers, restoration of mobility in the interphalangeal and metacarpophalangeal joints. Thus, the treatment of arteriovenous malformation of the hand should be based on the latest research findings and the most advanced testing technologies. This clinical case demonstrates that open surgery can be considered as an effective and sustainable clinical approach with a good medium-term outcome for the patients with arteriovenous malformation of the hand.

артериовенозная мальформациясосудистая мальформацияхирургия кистиэндоваскулярная хирургиясклерозированиеarteriovenous malformationvascular malformationhand surgeryendovascular surgerysclerotherapyReferencesMulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics. Plast Reconstr Surg. 1982;69(3):412–422. https://doi.org/10.1097/00006534-198203000-00002.Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics. Plast Reconstr Surg. 1982;69(3):412–422. https://doi.org/10.1097/00006534-198203000-00002.Upton J, Coombs CJ, Mulliken JB, Burrows PE, Pap S. Vascular malformations of the upper limb: A review of 270 patients. J Hand Surg Am. 1999;24(5):1019–1035. https://doi.org/10.1053/jhsu.1999.1019.Upton J, Coombs CJ, Mulliken JB, Burrows PE, Pap S. Vascular malformations of the upper limb: A review of 270 patients. J Hand Surg Am. 1999;24(5):1019–1035. https://doi.org/10.1053/jhsu.1999.1019.Ek ET, Nina S, Michelle GC. Vascular Anomalies of the hand and wrist. J Am Acad Orthop Surg. 2014;22(6):352–360. https://doi.org/10.5435/JAAOS-22-06-352.Ek ET, Nina S, Michelle GC. Vascular Anomalies of the hand and wrist. J Am Acad Orthop Surg. 2014;22(6):352–360. https://doi.org/10.5435/JAAOS-22-06-352.Yakes WF, Rossi P, Odink H. How I do it? Arteriovenous malformation management. Cardiovasc Intervent Radiol. 1996;19:65–71. https://doi.org/10.1007/BF02563895.Yakes WF, Rossi P, Odink H. How I do it? Arteriovenous malformation management. Cardiovasc Intervent Radiol. 1996;19:65–71. https://doi.org/10.1007/BF02563895.Garzon MC, Huang JT, Enjolras O, Frieden IJ. Vascular malformations: Part I. J Am Acad Dermatol. 2007;56(3):353–374. https://doi.org/10.1016/j.jaad.2006.05.069.Garzon MC, Huang JT, Enjolras O, Frieden IJ. Vascular malformations: Part I. J Am Acad Dermatol. 2007;56(3):353–374. https://doi.org/10.1016/j.jaad.2006.05.069.Rockman CB, Rosen RJ, Jacobowitz GR. Transcatheter embolization of extremity vascular malformations: The long-term success of multiple interventions. Ann Vasc Surg. 2003;17(4):417–423. https://doi.org/10.1007/s10016-003-0029-7.Rockman CB, Rosen RJ, Jacobowitz GR. Transcatheter embolization of extremity vascular malformations: The long-term success of multiple interventions. Ann Vasc Surg. 2003;17(4):417–423. https://doi.org/10.1007/s10016-003-0029-7.Jacobs BJ, Anzarut A, Guerra S, Gordillo G, Imbriglia JE. Vascular anomalies of the upper extremity. J Hand Surg Am. 2010;35(10):1703–1709. https://doi.org/10.1016/j.jhsa.2010.08.005.Jacobs BJ, Anzarut A, Guerra S, Gordillo G, Imbriglia JE. Vascular anomalies of the upper extremity. J Hand Surg Am. 2010;35(10):1703–1709. https://doi.org/10.1016/j.jhsa.2010.08.005.Kohout MP, Hansen M, Pribaz JJ, Mulliken JB. Arteriovenous malformations of the head and neck: Natural history and management. Plast Reconstr Surg. 1998;102(3):643–654. https://doi.org/10.1097/00006534-199809030-00006.Kohout MP, Hansen M, Pribaz JJ, Mulliken JB. Arteriovenous malformations of the head and neck: Natural history and management. Plast Reconstr Surg. 1998;102(3):643–654. https://doi.org/10.1097/00006534-199809030-00006.Visser A, Fitzjohn T, Tan ST. Surgical management of arteriovenous malformation. J Plast Reconstr Aesthet Surg. 2011;64(3):283-291. https://doi.org/10.1016/j.bjps.2010.05.033Visser A, Fitzjohn T, Tan ST. Surgical management of arteriovenous malformation. J Plast Reconstr Aesthet Surg. 2011;64(3):283-291. https://doi.org/10.1016/j.bjps.2010.05.033Hartzell LD, Stack BC, Yen J. Free tissue reconstruction following excision of head and neck arteriovenous malformations. Arch Facial Plast Surg. 2009;11:171–177 https://doi.org/10.1001/archfacial.2009.6.Hartzell LD, Stack BC, Yen J. Free tissue reconstruction following excision of head and neck arteriovenous malformations. Arch Facial Plast Surg. 2009;11:171–177 https://doi.org/10.1001/archfacial.2009.6.Yamamoto Y, Ohura T, Minakawa H. Experience with arteriovenous malformations treated with flap coverage. Plast Reconstr Surg. 1994;94(3):476–482. https://doi.org/10.1097/00006534-199409000-00009.Yamamoto Y, Ohura T, Minakawa H. Experience with arteriovenous malformations treated with flap coverage. Plast Reconstr Surg. 1994;94(3):476–482. https://doi.org/10.1097/00006534-199409000-00009.Hong JP, Choi JW, Chang H. Reconstruction of the face after resection of arteriovenous malformations using anterolateral thigh perforator flap. J Craniofac Surg. 2005;16(5):851–855. https://doi.org/10.1097/01.scs.0000187693.36765.38.Hong JP, Choi JW, Chang H. Reconstruction of the face after resection of arteriovenous malformations using anterolateral thigh perforator flap. J Craniofac Surg. 2005;16(5):851–855. https://doi.org/10.1097/01.scs.0000187693.36765.38.Goldenberg DC, Hiraki PY, Caldas LG. Surgical treatment of extracranial arteriovenous malformations after multiple embolizations: outcomes in a series of 31 patients. Plast Reconstr Surg. 2015;135(2):543–552. https://doi.org/10.1097/PRS.0000000000000890.Goldenberg DC, Hiraki PY, Caldas LG. Surgical treatment of extracranial arteriovenous malformations after multiple embolizations: outcomes in a series of 31 patients. Plast Reconstr Surg. 2015;135(2):543–552. https://doi.org/10.1097/PRS.0000000000000890.Liu AS, Mulliken JB, Zurakowski D. Extracranial arteriovenous malformations: natural progression and recurrence after treatment. Plast Reconstr Surg. 2010;125(4):1185–1194. https://doi.org/10.1097/PRS.0b013e3181d18070.Liu AS, Mulliken JB, Zurakowski D. Extracranial arteriovenous malformations: natural progression and recurrence after treatment. Plast Reconstr Surg. 2010;125(4):1185–1194. https://doi.org/10.1097/PRS.0b013e3181d18070.Garzon MC, Huang JT, Enjolras O, Frieden IJ. Vascular malformations: Part II. Associated syndromes. J Am Acad Dermatol. 2007;56(4):541–564. https://doi.org/10.1016/j.jaad.2006.05.066.Garzon MC, Huang JT, Enjolras O, Frieden IJ. Vascular malformations: Part II. Associated syndromes. J Am Acad Dermatol. 2007;56(4):541–564. https://doi.org/10.1016/j.jaad.2006.05.066.Lee BB, Baumgartner I, Berlien HP, Bianchini G, Burrows P, Do YS. Current concepts on the management of arteriovenous malformations consensus document of the International Union Angiology IUA – 2013. Int Angiol. 2013;32(1):9–36. Available at: https://pubmed.ncbi.nlm.nih.gov/23435389.Lee BB, Baumgartner I, Berlien HP, Bianchini G, Burrows P, Do YS. Current concepts on the management of arteriovenous malformations consensus document of the International Union Angiology IUA – 2013. Int Angiol. 2013;32(1):9–36. Available at: https://pubmed.ncbi.nlm.nih.gov/23435389.Koshima I, Nanba Y, Tsutsui T. Free perforator flap for the treatment of defects after resection of huge arteriovenous malformations in the head and neck regions. Ann Plast Surg. 2003;51(2):194–199. https://doi.org/10.1097/01.SAP.0000044706.58478.73.Koshima I, Nanba Y, Tsutsui T. Free perforator flap for the treatment of defects after resection of huge arteriovenous malformations in the head and neck regions. Ann Plast Surg. 2003;51(2):194–199. https://doi.org/10.1097/01.SAP.0000044706.58478.73.Song JK, Patel AB, Duckwiler GR. Adult pial arteriovenous fistula and superior sagittal sinus stenosis: angiographic evidence for high-flow venopathy at an atypical location. Case report. J Neurosurg. 2002;96(4):792–795. https://doi.org/0.3171/jns.2002.96.4.0792.Song JK, Patel AB, Duckwiler GR. Adult pial arteriovenous fistula and superior sagittal sinus stenosis: angiographic evidence for high-flow venopathy at an atypical location. Case report. J Neurosurg. 2002;96(4):792–795. https://doi.org/0.3171/jns.2002.96.4.0792.Fujiki M, Ozaki M, Iwashina Y, Takushima A. Clinical outcomes and recipient vessel selection for free flap transfer following arteriovenous malformation resection. J Plast Surg and Hand Surg. 2019;53(1):56–59. https://doi.org/10.1080/2000656X.2018.1541325.Fujiki M, Ozaki M, Iwashina Y, Takushima A. Clinical outcomes and recipient vessel selection for free flap transfer following arteriovenous malformation resection. J Plast Surg and Hand Surg. 2019;53(1):56–59. https://doi.org/10.1080/2000656X.2018.1541325.Toh S, Tsubo K, Arai H. Vascularized free flaps for reconstruction after resection of congenital arteriovenous malformations of the hand. J Reconstr Microsurg. 2000;16(7):511–517. https://doi.org/10.1055/s-2000-8388.Toh S, Tsubo K, Arai H. Vascularized free flaps for reconstruction after resection of congenital arteriovenous malformations of the hand. J Reconstr Microsurg. 2000;16(7):511–517. https://doi.org/10.1055/s-2000-8388.

The authors declare that there are no conflicts of interest present.