Ultrasound-Guided Transcatheter Ethanol Injection and Sclerotherapy of an Arteriovenous Malformation of the Foot

Abstract

Introduction Arteriovenous malformations (AVMs) are abnormal, direct connections between the arteries and veins. AVMs are most commonly associated with the brain and spinal cord; however, they can occur in any part of the body. Duplex ultrasound can play a pivotal role in both the diagnosis and treatment of AVMs. Methods A high-resolution duplex ultrasound machine along with a high-frequency 15–7 MHz probe was used in transcatheter techniques to treat an AVM. Ultrasound was used to guide arterial and venous access, target specific vessels for treatment, and ultimately reduce radiation exposure. Case Report A 6-year-old female patient was diagnosed with a left foot AVM and hemihypertrophy (Parkes Weber). Despite previous treatments with coil embolization, the patient developed discoloration and swelling of the left second toe and a nonhealing ulceration on the plantar aspect of the left foot. Duplex ultrasound was used to confirm the diagnosis and to aid in the treatment of the AVM. Under ultrasound guidance, catheter access was achieved via the dorsalis pedis artery and advanced distally into a large digital artery directly associated with the AVM. Anhydrous ethanol alcohol was injected through the catheter to treat the arterial inflow of the AVM. Ultrasound was then used to identify cavernous veins on the plantar aspect of the foot and to guide direct ethanol injections into the affected veins. Two weeks after the procedure, ultrasound confirmed 90% reduction in the AVM. The patient's toe discoloration resolved, and the ulceration healed. Conclusion Undiagnosed or poorly managed AVMs of the extremities can result in multiple surgical resections and skin deterioration. Ultrasound imaging of arteriovenous malformations with B-mode, color, and Doppler is essential for the evaluation (staging), treatment, and follow-up of vascular malformations. Ultrasound-guided transcatheter and direct techniques can be used in the treatment and prolonged management of AVMs. The application of ultrasound during these treatments will reduce radiation exposure in these patients.