# Integrating Palliative Care in the Intensive Care Unit for a Lethal Cervical Arteriovenous Malformation in a Reproductive-Aged Woman: A Case Report

## TL;DR

This case report highlights the challenges of treating a severe neck AVM and the benefits of integrating palliative care early in ICU settings for complex, life-limiting conditions.

## Contribution

The paper emphasizes the novel integration of palliative care in the ICU for a rare, lethal AVM case, improving patient and family outcomes.

## Key findings

- The patient's AVM was unresponsive to multiple interventions, leading to persistent bleeding and death.
- Early palliative care improved symptom management and provided psychosocial support to the patient and family.
- The case underscores the importance of combining palliative care with ICU treatment for life-limiting conditions.

## Abstract

Arteriovenous malformations (AVMs) of the head and neck are rare congenital vascular anomalies. Despite advances in endovascular techniques, extensive lesions can be difficult to manage and may lead to high morbidity. In rare cases, AVMs can become life-threatening, especially when located in the neck, where airway and vascular involvement can cause uncontrollable hemorrhage. Although intensive and palliative care are often seen as opposing approaches, they share common goals of symptom management, communication, and patient-centered decision-making in life-threatening illnesses.

We describe the case of a 38-year-old woman with a large, diffuse neck AVM located in the left parotid gland, extending into the left masticator space and downward. The primary arterial supply was from the left external carotid artery. The AVM was complicated by recurrent bleeding and airway obstruction. Despite multiple treatments, including endovascular embolization, vincristine therapy, and surgery, the patient experienced persistent bleeding, repeated shock episodes, and a gradual decline leading to death during a 36-day hospital stay. Palliative care was brought in on hospital day 8 for symptom control, anxiety management, and family support.

This case demonstrates the challenges of managing an aggressive vascular lesion and underscores the critical importance of early, concurrent integration of palliative care within the ICU paradigm for patients with complex, life-limiting illnesses. Early palliative involvement allowed for proactive symptom control, clarified care goals, and offered psychosocial support to her family. Ultimately, after compassionate withdrawal of life-sustaining treatments and organ donation, the patient passed away. This case emphasizes the significance of early, structured palliative care in ICU settings, particularly in conditions with poor prognosis despite maximum intervention.