Septic shock due to infected giant venous malformation complicated by massive bleeding

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Critical Care Medicine

Background:

• Massive venous malformations can lead to life-threatening complications such as shock.
• Hemorrhage and infection in extensive vascular anomalies present significant management challenges.

Observation:

• A 19-year-old male presented with shock secondary to a large arm and axillary hemangioma, complicated by hemorrhage and sepsis.
• Initial management with fluid resuscitation was ineffective; the patient exhibited signs of coagulopathy and limb ischemia.

Findings:

• Angiographic endovascular embolization was performed to reduce blood flow to the hemangioma.
• Continuous hemodiafiltration with a polymethylmethacrylate membrane was initiated for hypercytokinemia and damage control.
• Successful left arm amputation and latissimus dorsi flap reconstruction followed, leading to patient recovery.

Implications:

• This case highlights the successful application of a damage control approach in managing a rare, life-threatening vascular malformation.
• Multidisciplinary interventions, including endovascular techniques and extracorporeal therapies, are crucial for critical vascular emergencies.
• Damage control strategies can effectively stabilize patients with severe hemorrhage and sepsis from complex vascular anomalies.