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Updated: Jun 12, 2025

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Symptomatic arteriovenous malformation and peripheral arterial disease treated with intra-vascular lithotripsy and
Jonathan P Kerr1,2, Emily L Unrue1, Robert W Abdu1
1Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, PA.
Abstract:
An 87-year-old male presented with a painful, pulsatile mass on the left leg, diagnosed as a high-flow arteriovenous malformation (AVM) with an occluded, calcified popliteal artery. The AVM was sustained by collateral flow from the anterior tibial and peroneal arteries. To enable catheter access to feeding tibial vessels and restore distal perfusion via the dominant posterior tibial artery, intravascular lithotripsy and balloon angioplasty were performed before coil embolization. Completion angiography confirmed successful popliteal revascularization, restored tibial flow, and AVM resolution. This case highlights the importance of addressing arterial inflow before AVM embolization in patients with peripheral arterial occlusive disease.
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