Unique Presentation of an Arteriovenous Malformation (AVM) in the Hand: A Case Report.

Arteriovenous malformations (AVMs) of the hand are challenging high-flow vascular anomalies. While often stable for years, they can progress into higher Schobinger stages, where ulceration, hemorrhage, distal ischemia, and, in advanced cases, congestive heart failure are characteristic. Incomplete prior interventions often exacerbate these outcomes. A 39-year-old male with a 12-year history of a stable hand AVM presented with sudden expansion, spontaneous hemorrhage, and gangrenous skin changes. Clinical evaluation revealed hematoma and vascular steal syndrome. Imaging (MRI and DSA) confirmed a large (8x7x6 cm) extratruncular high-flow AVM involving the volar and ulnar aspects of the hand. The patient was managed with intravenous antibiotics and a staged multidisciplinary approach including selective arterial embolization with mechanical coils and liquid embolic agents, followed by radical surgical excision 48 hours later. Advanced hand AVMs require a "total obliteration" strategy. This case highlights the success of combining endovascular modulation with surgical resection to achieve limb salvage in a stage III lesion. Lifelong surveillance is mandatory due to the high risk of recurrence from dormant microscopic vascular nests.