Symptomatic arteriovenous malformation and peripheral arterial disease treated with intra-vascular lithotripsy and coil embolization.

An 87-year-old male presented with a painful, pulsatile mass on the left leg, diagnosed as a high-flow arteriovenous malformation (AVM) with an occluded, calcified popliteal artery. The AVM was sustained by collateral flow from the anterior tibial and peroneal arteries. To enable catheter access to feeding tibial vessels and restore distal perfusion via the dominant posterior tibial artery, intravascular lithotripsy and balloon angioplasty were performed before coil embolization. Completion angiography confirmed successful popliteal revascularization, restored tibial flow, and AVM resolution. This case highlights the importance of addressing arterial inflow before AVM embolization in patients with peripheral arterial occlusive disease.