Case#12

History: Young female with history of calf pain. No skin lesion. No size difference between the calves. Clinically AVM (arteriovenous malformation) is suspected. 

Imaging Studies:

  • MRI / MRA: Time-of-Flight (TOF) and contrast enhanced MR angiography (MRA) was performed (See the images below).

       

1st image is TOF MRA (actually MRV or MR venography). There is an obvious relatively large caliber vasculature seen in the lateral calf demonstrating strong venous flow (directed back to the heart). 2nd and 3rd images are contrast-enhanced MRA demonstrating early opacification of the vasculature (arteries and veins) in the diseased leg. Based on these MR findings, arteriovenous fistula (AVF) is suspected. AVM is much less likely.

  • DSA (Conventional Angiography) study was performed (see below) to confirm the diagnosis and evaluate the malformation for possible embolization. 

              

1st and 2nd DSA images show enlargement of the arterial system in the diseased leg, which is secondary to arteriovenous shunting. 3rd and 4th images demonstrate direct arteriovenous communication (AVF) with early filling of the normal appearing deep veins. The communication channel is very short or just a fenestration. 

Diagnosis: AVF (Arteriovenous Fistula)

Treatment / Discussion: This lesion should be treated surgically rather than transcatheter means. Transcatheter embolization would be technically challenging due to short arteriovenous communication. Surgical ligation of the arterio-venous fistula is recommended in this case.

 

 

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