Combined approach to management of periocular arteriovenous malformation by interventional radiology and surgical excision

Periorbital arteriovenous malformations (AVMs) are congenital lesions that may cause significant morbidity such as amblyopia, cosmetic disfigurement, or chronic pain. Due to the rarity of these lesions, they are frequently misdiagnosed and treated inappropriately. We managed a 6-year-old girl with preseptal AVM by endovascular embolization followed by complete surgical excision after 2 days. She was previously diagnosed as capillary hemangioma and was being treated with intralesional steroid injections and oral propranolol. Neuroimaging revealed an AVM fed by the branches of both external and internal carotid arteries and drained by the superior ophthalmic vein. Endovascular embolization with glue followed by complete surgical excision of the lesion was done. The resultant cosmetic and functional outcome was gratifying. Diagnosis and management of periorbital AVM remain a challenge requiring a multidisciplinary approach involving interventional radiologist and trained oculoplastic surgeons. Combined endovascular embolization followed by surgical excision proved safe and effective.

Pseudoaneurysm in gall bladder fossa following laparoscopic cholecystectomy.

A 32-year-old lady presented with severe hematemesis and melena after laparoscopic cholecystectomy. Initial ultrasonography and spiral CT suggested a vascular lesion in the gall bladder fossa. Selective hepatic angiography confirmed the presence of a pseudoaneurysm close to the surgical clip and filling through the right hepatic artery. This was treated with coil embolization, resulting in cessation of hematemesis and amelioration of symptoms.