Neonatal upper limb arteriovenous malformation: a therapeutic challenge

Arteriovenous malformations (AVMs) are rare congenital vascular malformations with associated morbidities. We describe a neonatal case of upper limb high-flow AVM presenting with upper limb soft tissue mass and postnatal high-output heart failure. Doppler study suggested high-flow AVM, and later magnetic resonance angiography of the right upper limb confirmed the diagnosis. The baby was managed with respiratory support, compression bandage and limb elevation, oral sirolimus and percutaneous embolisation. After percutaneous embolisation using glue, there was a reduction in the size of swelling with wound healing. Post embolisation, the baby remained haemodynamically stable on room air and gained weight on breastfeeds. Treatment of upper limb AVMs is best achieved with a multidisciplinary team to obliterate the arteriovenous shunt to prevent high-output cardiac failure and improve the quality of life.