Arteriovenous Malformations in the Foot: Treatment Options and Concerns

Arteriovenous malformation of the foot?

Hello, doctor.
I have been diagnosed with arteriovenous malformation (AVM) in my left foot.
MRI and ultrasound have revealed several hemangiomas.
I have previously undergone surgery and two sclerotherapy treatments without issues, but during the third sclerotherapy injection, it caused tissue necrosis due to vascular embolism, resulting in a wound approximately 3x6 cm in size.
I would like to ask what other treatment options are available besides sclerotherapy, as the tumors are enlarging and compressing nerves, making walking uncomfortable, and I am hesitant to undergo sclerotherapy again.
Is this a congenital condition? Is it hereditary? Can I apply for a major illness card or a disability handbook? Thank you.

Abby, 30~39 year old female. Ask Date: 2016/04/09

Dr. He Dongjin reply Cardiology

Hello, it is a congenital disease! It is hereditary! Besides sclerotherapy, I am not sure what other treatments are available.
I do not meet the qualifications to apply for a major illness card or a disability handbook.
Changhua Hospital cares about you.

Reply Date: 2016/04/09

More Info

Arteriovenous malformations (AVMs) in the foot can be complex and challenging to manage, especially when they lead to complications such as tissue necrosis or significant pain. Your experience with previous treatments, including surgical intervention and sclerotherapy, is not uncommon, as AVMs can be resistant to treatment and may require a multidisciplinary approach for optimal management.

Treatment Options for AVMs
1. Sclerotherapy: While you have already undergone sclerotherapy, it remains one of the primary treatments for AVMs. However, as you've experienced complications, it is crucial to discuss with your healthcare provider the risks and benefits of further sclerotherapy sessions. Sometimes, a different sclerosing agent or technique may be employed to minimize risks.

2. Surgical Resection: In cases where the AVM is localized and accessible, surgical resection may be considered. This involves removing the AVM and any affected tissue. However, this approach can be complex, especially if the AVM is intertwined with critical structures such as nerves or blood vessels.

3. Embolization: This is a minimally invasive procedure where materials are injected into the blood vessels feeding the AVM to reduce blood flow and size. It can be used as a standalone treatment or in conjunction with surgery.

4. Radiation Therapy: Stereotactic radiosurgery may be an option for certain types of AVMs, particularly those that are not amenable to surgical resection. This treatment uses focused radiation to shrink the malformation over time.

5. Pain Management: Given your discomfort and the pressure on nerves, a pain management specialist may help you manage symptoms through medications, nerve blocks, or other interventions.

6. Physical Therapy: Engaging in physical therapy can help improve mobility and strength in the affected area, potentially alleviating some discomfort associated with walking.

Understanding the Condition
AVMs are often congenital, meaning they are present at birth, but they may not become symptomatic until later in life. The exact cause of AVMs is not fully understood, but they can have a genetic component, particularly in syndromic cases. If there is a family history of vascular malformations, it may be worth discussing this with your healthcare provider.

Disability and Support
Regarding your inquiry about applying for a major illness card or disability assistance, eligibility can vary based on local regulations and the severity of your condition. It is advisable to consult with your healthcare provider or a social worker who can guide you through the application process based on your specific medical situation and local laws.

Conclusion
In summary, while sclerotherapy is a common treatment for AVMs, there are several other options available, including surgical resection, embolization, and radiation therapy. It is essential to have a thorough discussion with your healthcare team to determine the best course of action tailored to your specific case. Additionally, understanding the congenital nature of your condition and exploring support options can help you manage the challenges associated with AVMs effectively. Always ensure that you have a supportive network and access to the necessary resources as you navigate your treatment journey.

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