Suspected multifocal vascular involvement in a patient with long-standing upper limb arteriovenous malformation: A Case Report

Abstract Introduction Arteriovenous malformations (AVMs) are usually localised at initial presentation; however, they are characterised by a progressive course with the potential for expansion and recurrence following treatment. Multi visceral involvement has also been described in more complex cases. Case Description We report a rare case of a long-standing upper limb AVM with subsequent clinically significant suspected visceral and thoracic vascular lesions in a 51-year-old man who initially presented with a left upper limb AVM. He underwent a below-elbow amputation 25 years earlier, followed by an above-elbow amputation 10 years later due to recurrence at the stump. He subsequently presented with recurrence at the above-elbow stump, necessitating a mid-arm amputation. Following the mid-arm amputation, the patient subsequently developed intractable per rectal and intrathoracic bleeding associated with suspected visceral and thoracic vascular lesions and ultimately succumbed to the disease. Discussion This case highlights the rare and aggressive course of a long-standing upper limb AVM with suspected multifocal visceral involvement and life-threatening vascular complications at multiple anatomical sites despite repeated surgical interventions. It underscores the importance of early recognition of multifocal disease, the need for comprehensive systemic evaluation, and a multidisciplinary approach to management.