Successful surgical resection of giant arteriovenous malformation in supraclavicular fossa Kohei Horikawa, MD, Hiroyuki Nishi, MD, Naosumi Sekiya, MD,

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Successful surgical resection of giant arteriovenous malformation in supraclavicular fossa Kohei Horikawa, MD, Hiroyuki Nishi, MD, Naosumi Sekiya, MD, Mitsutomo Yamada, MD, Toshiki Takahashi, MD Journal of Vascular Surgery Cases and Innovative Techniques Volume 4, Issue 2, Pages 91-94 (June 2018) DOI: 10.1016/j.jvscit.2017.12.010 Copyright © 2018 The Author(s) Terms and Conditions

Fig 1 Preoperative computed tomography (CT) findings. a, Findings obtained with three-dimensional CT revealed feeding arteries and drainage veins around the mass. b1, Clavicular branch of left internal mammary artery. b2, Transverse cervical artery feeding the arteriovenous malformation (AVM). b3, At least three drainage veins were shown (arrows). c, Preoperative magnetic resonance imaging and angiography findings. An AVM is seen compressing the brachial plexus (arrows). d, Four major feeding arteries were shown: 1, transverse cervical artery; 2, clavicular branch of left internal mammary artery; 3, thoracoacromial artery; and 4, anterior/posterior circumflex humeral artery. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 91-94DOI: (10.1016/j.jvscit.2017.12.010) Copyright © 2018 The Author(s) Terms and Conditions

Fig 2 Surgical procedures. a, The left clavicle was removed to expose the arteriovenous malformation (AVM; asterisk). The edge of the clavicle was visualized (arrow). b, Feeding arteries (asterisks) were detected and divided, marked with silicone tapes, and were then divided with ligation. c, An ultrasonic scalpel was used near the brachial plexus (asterisk). The AVM (▲) was retracted with forceps. d, Drainage veins (asterisks) were clamped. e, The AVM was completely excised. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 91-94DOI: (10.1016/j.jvscit.2017.12.010) Copyright © 2018 The Author(s) Terms and Conditions

Fig 3 Postoperative computed tomography (CT) findings. a, No mass enhancement was seen near the left subclavian artery (circle). b, Complete resection of the mass is shown (circles). The arrows note the titanium plate used to fix the clavicle. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 91-94DOI: (10.1016/j.jvscit.2017.12.010) Copyright © 2018 The Author(s) Terms and Conditions