Sylvester Briana, Sundaram Niteesh, Marica Silviu, Cagir Burt, Ronsivalle Joseph
School of Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA.
General Surgery, Crozer-Chester Medical Center, Upland, USA.
Cureus. 2023 Jul 5;15(7):e41431. doi: 10.7759/cureus.41431. eCollection 2023 Jul.
An arteriovenous malformation (AVM) refers to an anomalous, direct connection between an artery and a vein. Typically, these two vessels are interposed by high-resistance capillary beds, the absence of which results in a high-flow system from an artery into a vein. Venous vessel walls are not designed to handle such high-pressure blood flow, and their vessel wall structure becomes permanently altered and weakened. For this reason, AVMs are at an increased risk for hemorrhages and ruptures. AVMs present with a spectrum of symptoms, ranging from skin discoloration, ischemia in distal tissues, and heart failure from arteriovenous shunting. Here, we present a case of a patient who underwent amputation of his second left toe, initially thought to be a result of peripheral arterial disease (PAD) due to his extensive smoking history. Further imaging findings revealed a rare lower-extremity AVM as the source of his ischemia, not PAD. Ultimately, the treatment of the vascular anomaly and resolution of the patient's symptoms were achieved via transarterial embolization. This case emphasizes the importance of looking beyond PAD as the cause of distal lower-extremity ischemia and provides insights into an uncommon and often missed diagnosis of extracranial AVMs.
动静脉畸形（AVM）是指动脉与静脉之间的一种异常直接连接。通常情况下，这两种血管之间由高阻力的毛细血管床分隔，而毛细血管床的缺失会导致形成从动脉到静脉的高流量系统。静脉血管壁无法承受如此高压力的血流，其血管壁结构会发生永久性改变并变弱。因此，动静脉畸形发生出血和破裂的风险增加。动静脉畸形可表现出一系列症状，包括皮肤变色、远端组织缺血以及动静脉分流导致的心力衰竭。在此，我们报告一例患者，该患者接受了左足第二趾截肢手术，最初因其大量吸烟史被认为是外周动脉疾病（PAD）所致。进一步的影像学检查结果显示，其缺血的根源是一种罕见的下肢动静脉畸形，而非外周动脉疾病。最终，通过经动脉栓塞术实现了对血管异常的治疗并缓解了患者的症状。该病例强调了在诊断下肢远端缺血时不能仅局限于外周动脉疾病的重要性，并为颅外动静脉畸形这种不常见且常被漏诊的疾病提供了见解。
