Multiple arteriovenous malformations due to liver failure: An unusual etiology

Arteriovenous malformations (AVMs) are rare vascular anomalies, predominantly congenital and intracranial. We report a unique case of multiple extracranial acquired AVM in a 44-year-old man with ethanol-related decompensated chronic liver disease presenting with severe gingival hemorrhage. Angiography showed focal microarteriovenous shunting with early venous drainage in the absence of a mature, compact nidus involving the facial and lingual arterial systems, which was successfully treated with endovascular embolization. In the absence of earlier vascular pathology, an acquired etiology is suspected. Cirrhosis-associated angiogenic and inflammatory dysregulation may contribute to de novo AVM formation, and reported regression following liver transplantation suggests a potentially reversible, hepatic-driven mechanism.