CASE REPORT Postoperative Use of the NormaTec Pneumatic Compression Device in Vascular Anomalies

Abstract

Arteriovenous malformations have a wide range of clinical presentations and an unfortunately unpredictable response to both nonsurgical and surgical intervention. The authors report on the surgical treatment of a 19-year-old man with a complex lower extremity arteriovenous malformation, previously unsuccessfully treated with numerous local sclerotherapy and interventional radiology embolization procedures leading to massive tissue necrosis and deep infection. The patient was definitively treated with wide excision of the necrotic tissue, coils, and arteriovenous malformation, but with preservation of the tibial nerve and vascular supply to the foot. Significant postoperative complications were prevented with the use of a novel dynamic compression device employing peristaltic pulse pneumatic compression.

Figure 1

Preoperative angiogram demonstrating malformation with multiple coils.

Figure 2

Preoperative wound with exposed coils.

Figure 3

Coils were removed at surgery and the posterior tibial nerve was protected.

Figure 4

Angiogram after our first case demonstrating residual coils and vascular supply to the foot. A perforator joining the anterior and posterior circulations is marked 74 mm above the lateral malleolus.

Figure 5

Postoperative appearance, with full wound healing and minimal residual edema.