Arteriovenous malformation on the sole of the foot treated successfully by embolization

Abstract

Arteriovenous malformations of the sole of the foot are rare and can cause disturbances in normal living activities. We report a case of a plantar arteriovenous malformation in a 24-year-old male with pain and difficulty in walking. The arteriovenous malformation was complex, with a large and poorly marginated nidus, so we considered that with surgical resection, walking disabilities would be inevitable. When surgical removal of vascular mass is difficult, embolization alone can be effective. Therefore, he was treated with 4 therapeutic embolization procedures. Transvenous approaches to the venous sac and direct punctures of the nidus was performed. The nidus was successfully eradicated by embolization using alcohol, resulting in the disappearance of associated symptoms. Appropriate imaging is essential for diagnosis and evaluation of treatment. We were successful in achieving improved quality of life and satisfaction for a rare and difficult case by percutaneous embolization and sclerotherapy.

Hybrid surgery of arteriovenous malformation and aneurysm of the sole

“…9 Noninvasive investigations such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are frequently used to diagnose peripheral lesions; however, for diagnosing AVM, an invasive investigation using angiography can also be applied. 3 While ultrasound shows multiple vascular channels with supplying arteries, nidus, and draining veins as multiple anechoic spaces, 13 catheter angiography is the gold standard for identifying the primary blood supply to the vascular malformation, the existence of a nidus, the magnitude of arteriovenous shunting, and venous drainage. 14 The primary treatment for AVM of the sole is surgical excision with ligation or embolization of the feeding vessels.…”

“…Selecting the most suitable agent depends on two parameters: (1) the size of the vessel and (2) the temporary or permanent closure of the vessel 15,16 . Coil embolization of the feeding artery is a challenging and potentially dangerous procedure due to the formation of numerous collateral feeders that shift blood to the nidus 3 . Embolization can alleviate symptoms within an approximate range of 40%–80% of the cases and cure the problem completely in 10% of patients; however, the recurrence rate of diffuse AVM in extremities is about 50% 17 .…”

“…The therapeutic target for AVMs is to eradicate the nidus in order to alleviate symptoms and prevent recurrence. Surgical excision in such a case is a difficult procedure as AVMs commonly develop within normal tissue where the irreversible loss of normal functioning is unavoidable 3 . AVMs near joints, tendons, and ligaments could have an adverse impact on such tissues.…”

“…AVMs can be found in different body parts but are most frequently found on the head, neck, and lower extremities 2 . AVM of the sole is a rare disease that can impede normal activities 3 . The first case report related to AVM of the sole was published in 1969.…”

Pelvic arteriovenous malformation (AVM) with recurrent hematuria: A case report

“…Numerous noninvasive diagnostic methods can be used for diagnosing pelvic AVMs, including contrast-enhanced CT scan, Magnetic Resonance Imaging (MRI), and color Doppler ultrasound [ 14 ]. Nonetheless, angiography, which is an invasive diagnostic modality, is the gold standard for differentiating between primary blood circulation and vascular malformation, detecting a nidus, evaluating the magnitude of arteriovenous shunting, and venous drainage [ 15 , 16 ].…”