Congenital Arteriovenous Malformation of the Hand and Forearm: Integration of Clinical Staging, Vascular Imaging, and Treatment Outcomes in a Rare Anomaly

Abstract

Congenital arteriovenous malformations (AVMs) involving the hand and forearm are exceptionally rare developmental vascular disorders and pose considerable diagnostic and therapeutic challenges because of their complex vascular anatomy. These lesions arise from anomalous direct arterial–venous connections, resulting in high-flow circulation that may progressively lead to pain, swelling, and impairment of hand function. Although AVMs are more frequently described in the central nervous system, their occurrence in the hand remains infrequent and clinically challenging. We report the case of an 11-year-old female child presented with progressively increasing pain and swelling of the right hand. Clinical and Radiological evaluation with magnetic resonance imaging and angiography established the diagnosis of a congenital arteriovenous malformation, corresponding to Schobinger stage III. Management was planned in a staged and multidisciplinary manner. Initial endovascular embolization was performed to reduce blood flow within the lesion, followed by complete surgical excision. Careful identification and ligation of the principal feeding vessels were central to achieving effective intraoperative hemostasis and complete R0 resection. The postoperative recovery was uneventful, with significant relief of symptom and preservation of hand and upper limb function. No recurrence was detected during the follow-up period. This case demonstrates that careful preoperative assessment, appropriate staging, and a combined endovascular and surgical approach can result in satisfactory outcomes in congenital AVMs of the hand.