Functional outcomes after surgical management of peripheral AVM at a tertiary care center

Abstract

Introduction: Arteriovenous (AV) malformations (AVMs) are rare vascular developmental orders containing an arterial network draining directly into one or more veins without a capillary bed, accounting for 1.5% of total vascular anomalies. Clinical presentations include pulsating mass, pain, ulceration, bleeding, tissue necrosis, enlargement of draining vein, and venous hypertension and/or cardiac failure. Treatment modalities include surgical excision, coil embolization, and sclerotherapy. Surgical excision offers an opportunity for cure but is associated with a risk of injury to vital structures, causing permanent impairment. Due to the high-risk nature of the lesion, it is important to study the clinical presentation and management of peripheral AVM for better management of these patients. Objectives: The objective was to study the presentation, management, and postoperative outcomes in terms of recurrence and functional status of the limb after surgical management of AVMs. Patients and Methods: It was a retrospective study done for 5 years (2018–2023). Thirteen patients who underwent surgical excision of peripheral AVM were included. Recurrence and functional status were assessed by clinical evaluation during follow-up outpatient department visits. Conclusion: The mean age of presentation is 33 years, with male preponderance (70%). Seven patients had upper limb AVMs (four had forearm involvement, while the rest had elbow region involvement). Six patients had lower limb AVMs, out of which four patients had involvement of the thigh region, one had in the knee, and the other in the calf. All patients complained of difficulty in performing daily activities due to the lesion. Nine patients underwent direct surgical excision, and four patients underwent AVM embolization before surgery (three patients had coil embolization, and one had onyx embolization). The mean duration of stay in the hospital was 5 days. Three patients were advised body contour stockings at follow-up. Two patients had recurrence (one after 6 months of surgical excision and the other had prior coil embolization), and one patient (had preembolization) had continued difficulty in walking postprocedure. The rest of the patients did not develop recurrence/functional impairment. There was no postoperative mortality. Thus, surgical excision offers a chance at cure with durable, functional outcomes in patients with peripheral AVMs.

Keywords

• arteriovenous malformation
• functional outcome
• surgical excision