切除を行わずIVRと植皮により寛解した足の動静脈奇形の1例

Arteriovenous Malformation of the Foot Treated Successfully by Embolization and Skin Graft

はじめに

　動静脈奇形の治療法は，外科的切除と再建，および血管内治療（interventional radiology：以下，IVR）の2つに大別され，駆血のできる四肢末端においては，切除が選択される場合も多い。しかし症例によっては，両者の併用，場合によってはIVR単独で著効する場合もある。IVRと植皮を行い，切除を行わずに寛解し社会復帰した足部の動静脈奇形症例を経験したので報告する。

　We report a case of arteriovenous malformation of the foot in a 33-year-old male with pain and difficulty in walking. The arteriovenous malformation was complex, affecting both the dorsal and sole sides of the metatarsals, and we therefore believed that walking disabilities would be inevitable if surgical resection were performed. The patient was treated with 4 therapeutic embolization procedures and a split-thickness skin graft. The angiographic classification of the nidus was type IIIb (arteriovenous fistulae with dilated fistula). Both approach, direct puncture and transarterial approach, were performed in every embolizations. The nidus was successfully eradicated by embolization using n-butyl-2-cyanoacrylate (NBCA) and absolute alcohol, resulting in the disappearance of the associated symptoms.