The Hand Surgeon's Role in the Management of Upper-Extremity Arteriovenous Malformation: A Review of the Literature.

Abstract

The diagnosis and treatment of fast-flow arteriovenous malformations with or without dynamic arteriovenous fistulae in the upper limb can be both frustrating and daunting for the hand surgeon. The clinical presentation can vary from an incidental finding to a pulsating mass, threatening the entirety of the upper extremity and precipitating cardiac failure secondary to diverging vasculature. Non-operative treatment is appropriate for the small, minimally symptomatic mass. However, considerable controversy remains regarding the management of symptomatic lesions, specifically regarding the utility of embolization or sclerotherapy and the aggressiveness of surgical resection, concepts that are dependent primarily on both the size and location of the lesion. Although classification schemes exist, which attempt to stratify the severity of the lesion encountered by the upper-extremity surgeon, they make no attempt to categorize its location based on clinical relevance. Therefore, our purpose was to review the etiology, clinical presentation, and management of arteriovenous malformations in the upper limb and to refine the present classification to include present treatment options for this uncommonly encountered pathology.