Article Figures & Data
Figures
- fig 1.
48-year-old woman with a congenital Klippel-Trenaunay syndrome of the left arm with cutaneous and subcutaneous angiodysplasia of left hemithorax associated with a paravertebral cervical AVM.
A, CT scan, obtained at the level of C7 before treatment, shows a massive erosion of the C7 vertebral body.
B, Sagittal T2-weighted spin-echo 2610/115 (TR/TE) MR image, obtained before treatment, shows the AVM with large epidural high-flow pouches.
C, Axial T1-weighted 500/18 MR image, obtained after contrast enhancement at the level of C6 before treatment, shows that the cord is shifted to the right (large arrow).
D, Anteroposterior view subtracted angiogram of the left subclavian injection, obtained during the arterial phase, shows several AVFs supplied by collaterals of the costocervical trunk and of the thyrocervical trunk. Note a large aneurysm at the origin of the left thyrobicervicoscapular artery (large arrow).
E, Anteroposterior view subtracted angiogram of the left subclavian injection, obtained during the venous phase, shows several AVFs supplied by collaterals of the costocervical trunk and of the thyrocervical trunk. Note a large aneurysm at the origin of the left thyrobicervicoscapular artery (large arrow) and the ectatic epidural and paraspinal veins draining the vascular malformation (small arrows).
F, Anteroposterior view subtracted hyperselective angiogram of a collateral of the left costocervical trunk, obtained before NBCA injection, shows an AVF.
G, Anteroposterior view subtracted angiogram of the left subclavian injection, obtained during the arterial phase 2 months after the first session of treatment, shows that the remnant AVM drained through a single venous pouch (asterisk).
H, Anteroposterior view subtracted angiogram of the left subclavian injection, obtained during the venous phase 2 months after the first session of treatment, shows that the remnant AVM drained through a single venous pouch (asterisk).
I, Anteroposterior view subtracted angiogram of the right subclavian injection, obtained 2 months after the first session of treatment, shows that the remnant AVM drained through a single venous pouch (asterisk).
J, Angiogram shows direct opacification of the same venous pouch as that shown in G through I, by retrograde venous catheterization, just before glue injection.
K, Anteroposterior view X-ray of the final cast of glue (NBCA mixed with lipiodol).
L, Anteroposterior view subtracted angiogram of the aortic arch, obtained 2 days after the end of treatment, shows a complete occlusion of the AVM.
M, Sagittal T2-weighted spin-echo 2610/115 MR image, obtained 6 months after the last session of treatment, shows no area of signal void, suggesting persistence of complete thrombosis.
