Peripheral arteriovenous malformations: Diagnosis and future prospects

Peripheral arteriovenous malformations (AVMs) are rare, high-flow vascular anomalies caused by errors in vasculogenesis or angiogenesis, frequently driven by mutations in the RAS/RAF/MEK/ERK signaling pathway. These lesions exhibit progressive behavior, leading to diverse clinical presentations ranging from localized pain, swelling and important bleeding to severe systemic complications such as high-output cardiac failure. AVMs pose significant diagnostic and therapeutic challenges due to their heterogeneous nature and high recurrence rates. Accurate diagnosis relies on advanced imaging modalities, including Doppler ultrasonography, magnetic resonance imaging and angiography, and digital subtraction angiography, which provide critical insights into lesion extent and flow dynamics. Current management strategies involve a combination of preoperative embolization, surgical excision, and endovascular therapies. However, incomplete treatment frequently results in recurrence, emphasizing the need for complete nidus removal. Emerging antiangiogenic therapies, such as thalidomide and MEK inhibitors, show promise as adjuncts to invasive treatments, potentially reducing recurrence rates and enhancing long-term outcomes. This review highlights the need for standardized treatment protocols, integrating clinical, anatomical, and genetic insights. Syndromic AVMs require broader diagnostic and therapeutic considerations, while advances in molecular genetics pave the way for targeted pharmacologic therapies. Future research should focus on refining combination therapies and optimizing individualized care through multidisciplinary approaches. While challenges remain, these developments represent significant steps toward improving outcomes for patients with this complex and debilitating vascular anomaly.