Volume 39, Pages (January 2018)

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Volume 39, Pages 40-43 (January 2018) Case Report of Ethanol and Cyanoacrylate Embolisation of a Recurrent Uncontrollable Torrentially Bleeding Arteriovenous Malformation of the Finger Darius K.L. Aw, Hao-Yun Yap, Luke H.T. Tay, Kiang-Hiong Tay, Tze-Tec Chong EJVES Short Reports Volume 39, Pages 40-43 (January 2018) DOI: 10.1016/j.ejvssr.2018.05.003 Copyright © 2018 The Authors Terms and Conditions

Figure 1 a. First presentation of AVM in 2014. The patient had open ligation of his radial artery and as well as embolization performed. Despite surgical and embolization therapy, bleeding was poorly controlled, requiring prolonged bandage over the right thumb as seen in the above picture. b. Subsequent presentation of AVM in 2017. Severe skin necrosis with bone exposure and torrential bleed were noted. c. 6 months post surgery with good wound healing and cessation of bleeding. EJVES Short Reports 2018 39, 40-43DOI: (10.1016/j.ejvssr.2018.05.003) Copyright © 2018 The Authors Terms and Conditions

Figure 2 a. Baseline angiography was obtained for evaluation. An angiogram was obtained, revealing a previously ligated radial artery, feeding branches from the ulnar artery and palmar arches. b. Large draining veins. c. With a pneumatic tourniquet and elastic bands at the base of the phalanges as mechanical constrictors, vascular stasis was achieved to reduce reflux and non target embolization of the digital arteries. EJVES Short Reports 2018 39, 40-43DOI: (10.1016/j.ejvssr.2018.05.003) Copyright © 2018 The Authors Terms and Conditions

Figure 3 a. The prominent draining veins were punctured with a 21G needle. A 4Fr microcatheter guidewire was advanced to cannulate the nidus. b. Absolute ethanol with lipiodol in 1:1 ratio was injected and incubated in the AVM for 3–5mins. c. Post ethanol embolization angiogram revealed suboptimal results with persistent contrast filling of the AVM. d. Direct puncture and embolization with 20% cyanoacrylate glue and ethanol was repeated. e. Multiple runs of glue and ethanol embolization were performed via different approaches, i.e inferior approach with cannulation via ulnar artery/palmar arch, superior approach with placement of embolization catheter via the digital artery of the index finger. f. Post embolization check angiogram revealed no further feeding arteries or contrast enhancement. EJVES Short Reports 2018 39, 40-43DOI: (10.1016/j.ejvssr.2018.05.003) Copyright © 2018 The Authors Terms and Conditions