{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T18:25:29Z","timestamp":1786991129025,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Arteriovenous malformations (AVMs) are a rare condition involving the trunk. We present a case of a 55\u2010year\u2010old woman affected by a giant dorsum\u2010abdominal\u2010pelvic AVM, even after multiple endovascular and surgical treatments over decades which required a different surgical approach. AngioCT scan was performed to identify the feeding vessels, the mass' extension and involvement of underlying tissues. Multidisciplinary discussion agreed on multistep treatment. First, we performed an en bloc resection starting from the right pelvis, moving cranially and laterally toward the right armpit, then removing medially toward the vertebral column, leaving a defect of 30\u2009\u00d7\u200910\u2009cm. Then a selective angiography and a paravertebral embolization of remaining AVM at the T7\u2010level were performed. Reconstruction was then completed with a left hemiabdomen DIEP free flap. We anastomosed one branch of the DIEA to the SCIA and one comitantae vein to the SCIV to assure lateral flow. Then we performed the anastomosis between the DIEA and the second comitantae vein respectively to a branch of TDA and to a branch of the serratus vein. The follow up at 6\u2009months has satisfactory results for both patient and surgeon. This challenging case could provide an alternative for radical surgical excision combined with an endovascular control and microsurgical reconstruction. We describe what we believe to be the first reported giant AVM treated with this sequence multistep surgeries.<\/jats:p>","DOI":"10.1002\/micr.70194","type":"journal-article","created":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T04:59:10Z","timestamp":1771649950000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Three Steps Hybrid Treatment: En Bloc Resection, Endovascular Treatment and Microsurgical Reconstruction. Case Report of a Giant Dorsum\u2010Abdominal\u2010Pelvic Arteriovenous Malformation"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9092-6939","authenticated-orcid":false,"given":"Iulia Elena","family":"Marin","sequence":"first","affiliation":[{"name":"Department of Plastic Reconstructive and Microsurgery AOU Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0095-2741","authenticated-orcid":false,"given":"Sara","family":"Tamburello","sequence":"additional","affiliation":[{"name":"Department of Plastic Reconstructive and Microsurgery AOU Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Mori","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Ortopedico Rizzoli  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice Letizia","family":"Andreoli","sequence":"additional","affiliation":[{"name":"Department of Plastic Reconstructive and Microsurgery AOU Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6959-4455","authenticated-orcid":false,"given":"Innocenti","family":"Alessandro","sequence":"additional","affiliation":[{"name":"Department of Plastic Reconstructive and Microsurgery AOU Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Santi","sequence":"additional","affiliation":[{"name":"Pathology Section, Department of Health Sciences University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1858-3964","authenticated-orcid":false,"given":"Giulio","family":"Menichini","sequence":"additional","affiliation":[{"name":"Department of Plastic Reconstructive and Microsurgery AOU Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2006.01.027"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1583\/05-1769.1"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.14193\/jkfas.2015.19.1.23"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(25)05346-7"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2010.08.005"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2010.02.053"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199809010-00006"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181d18070"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2017.08.028"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2012.10.047"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100560.2012.01913.x"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.2006.038885"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.10.074"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnis.2010.002972"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina48080058"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2010.05.033"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.169.2.3175000"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-009-4249-5"},{"key":"e_1_2_9_20_1","first-page":"228","volume-title":"Vascular Birthmarks: Hemangiomas and Malformations","author":"Young A. 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