PMC3350292_01
Large nonhealing leg ulcers.
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fig1
An 86-year-old woman first presented to the Vascular Center Clinic with a chronic nonhealing, painful ulcers over the medial malleolus and anterior left shin, Figure 1.
Large subcutaneous collateral veins.
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fig2
The collateral veins had not been mentioned previously, Figure 2.
(a) Normal-to-high signal in the left common femoral vein 3 years before presentation. (b) Increased Doppler velocity in the left common femoral vein 1 year prior to presentation. (c) Marked turbulence and high flow at the junction of the left great saphenous vein with the femoral vein.
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fig3
The duplex studies from previous years had shown a sequential increase in the femoral vein Doppler signal velocity and turbulence, Figures 3(a), 3(b), and 3(c).
3D reconstruction of the left pelvic AVM with outflow to the left external iliac vein and collateral veins leading to the right common femoral vein (not shown). The supplying arteries are the left internal iliac a. (arrow) and the left 5th lumbar a. (arrowhead).
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fig4
AVM with supplying arteries from the left internal iliac a. and the 5th lumbar artery, Figures 4(a) and 4(b). An embolization was performed using Onyx liquid embolic agent (EV3, Irvine, CA, USA) and embolization coils (Cook Inc, Bloomington, IN, USA), Figure 5.
(a) Arteriogram of the AVM, preembolization, left 5th lumbar artery (arrow head) and the left internal iliac artery (arrow) are the major feeding vessels. (b) Postembolization with Onyx (EV3, Irvine, CA, USA) and coils (Cook Inc).
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fig5
AVM with supplying arteries from the left internal iliac a. and the 5th lumbar artery, Figures 4(a) and 4(b). An embolization was performed using Onyx liquid embolic agent (EV3, Irvine, CA, USA) and embolization coils (Cook Inc, Bloomington, IN, USA), Figure 5.
Healing of the skin ulcers following embolization, endovenous ablation, and sclerotherapy.
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fig6
Compression bandages for another few weeks led to healing of the ulcers and complete resolution of the pain, Figure 6.