En bloc Surgical Excision of an Arteriovenous Malformation in the Foot: A Case Report and Review of the Literature

Abstract

Introduction: Arteriovenous malformations (AVM) are developmental vascular malformations consisting of abnormal arteriovenous shunts surrounding a central nidus. These lesions are relatively uncommon, comprising just 7% of all benign soft-tissue masses. Most AVMs occur in the brain, neck, pelvis, and lower extremity and rarely manifest in the foot. When they do form in the foot, non-specific pain and the absence of clinical features contribute to the high rate of misdiagnosis on initial presentation. Although surgical excision combined with embolotherapy has emerged as the preferred treatment for large AVM, controversy exists over the best treatment for small lesions in the foot. Case Presentation: A 36-year-old Afro-Caribbean man was referred to the clinic with a 2-year history of increasing pain in his forefoot, affecting his ability to stand or walk comfortably. There was no history of trauma, and despite changing his footwear, the patient continued to have significant pain. Clinical examination was unremarkable except for mild tenderness over the dorsum of his forefoot, and radiographs were normal. A magnetic resonance scan reported an intermetatarsal vascular mass but could not exclude malignancy. Surgical exploration and en bloc excision confirmed the mass to be an AVM. One year post-surgery, the patient remains pain-free with no evidence of recurrence. Conclusions: The rarity of AVM in the foot, combined with normal radiographs and non-specific clinical signs, contributes to the long delay in diagnosing and treating these lesions. Surgeons should have a low threshold for obtaining magnetic resonance imaging in cases of diagnostic uncertainty. En bloc surgical excision is an option for treating small suitably located lesions in the foot.

Hybrid surgery of arteriovenous malformation and aneurysm of the sole

“…The study describes the successful treatment of a rare type of arteriovenous malformation (AVM) in the sole using hybrid surgery, which consists of open resection and embolization. Moreover, the possibility of utilizing ultrasound during examination in addition to angiography for the diagnosing of AVM of the sole is proposed 1 . AVMs can be found in different body parts but are most frequently found on the head, neck, and lower extremities 2 .…”

“…Moreover, the possibility of utilizing ultrasound during examination in addition to angiography for the diagnosing of AVM of the sole is proposed. 1 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. Since then, only a limited number of papers regarding AVM of the sole have been published 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 and the current research it is believed to be the ninth published article regarding AVM of the sole to date.…”

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

“…As an abnormality of the development of capillaries, arteriovenous malformation (AVM) leads to a direct connection between arterial and venous networks, in which capillary branches are not involved [ 1 ]. Typically, these lesions are low-resistant and high-flow vascular channels with different sizes and locations [ 2 , 3 ].…”