Can Amputation be Justified for Extremity Arteriovenous Malformations? A Case Report and Scoping Review of Literature

Arteriovenous malformations (AVMs) are rare, congenital, high-flow vascular anomalies, that may become aggressive and threatening, especially in the extremities. We present the case of a 42-year-old male with a congenital AVM of the non-dominant hand, who presented at our emergency department with spontaneous, life-threatening hemorrhage. Despite previous embolization attempts, the lesion had progressed to Schobinger stage III. The patient underwent emergent mid-forearm amputation, which successfully controlled the hemorrhage and provided significant pain relief. Two years postoperatively, he remains free of recurrence, with excellent functional and psychological recovery. A comprehensive literature review was also performed, highlighting the role of amputation as a last-resort, but sometimes life-saving, intervention in advanced extremity AVMs. Although embolization and surgical resection remain the cornerstones of treatment, amputation may be necessary in cases of intractable symptoms, recurrent complications, or failure of other therapies. A multidisciplinary, patient-centered approach is critical for decision-making and optimal long-term outcomes.