Multiple Arterio Venous Malformations Due to Liver Failure: An Unusual Etiology

Abstract Arteriovenous malformations (AVMs) are rare vascular anomalies, predominantly congenital and intracranial. We report a unique case of multiple extra cranial acquired AVM in a 44-year-old man with ethanol-related decompensated chronic liver disease presenting with severe gingival hemorrhage. Angiogram showed focal micro–arteriovenous shunting with early venous drainage in the absence of a mature compact nidus involving the facial and lingual arterial systems, which were successfully treated with endovascular embolization. In the absence of prior 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.