Excessive limb growth and thickening is one of the clinical manifestations of congenital arteriovenous fistula, which is caused by abnormal development of the embryonic primordium during its evolution, resulting in abnormal traffic between the arteries and veins. How can congenital arteriovenous fistulas be effectively prevented? Localized congenital arteriovenous fistulas can be treated with good results by considering surgery. However, most congenital arteriovenous fistulas are very difficult to treat because of the many small traffic branches between the arteries and veins and the wide range of lesions, sometimes involving the entire limb, and interventional treatment is sometimes effective. 1. Indications for surgery â‘ Congenital arteriovenous fistulas with rapid growth should be treated by surgery as early as possible, preferably before 6 years of age in children. (2) With heart failure, the lesion involves peripheral nerves or the lesion is large and vulnerable to injury causing bleeding. The best surgical treatment is for those with slow and limited growth. (1) Arteriovenous fistula ligation of the main arterial branch proximal to the arteriovenous fistula is suitable for congenital arteriovenous fistula involving non-arterial arteries with extensive lesions that cannot be removed. (2) Arteriovenous fistulotomy is suitable for congenital arteriovenous fistulas with limited and superficial lesions, and the soft tissues involved should be removed together with the surgery. (3) Interventional embolization is less invasive than surgery and has become the main treatment for congenital arteriovenous fistula. The degree and extent of the lesion is clarified by arteriography, and embolization devices such as gelatin sponges, silicone plastic, stainless steel microspheres, polyvinyl alcohol, and stainless steel spring coils are released into the fistula site, but the possibility of recurrence is high, and sometimes multiple procedures are required in stages. (4) Amputation or arthrodesis Some patients may be considered if the above treatment is ineffective and is associated with heart failure, gangrene or severe infection of the affected limb, or recurrent hemorrhage. It must be noted that most congenital arteriovenous fistulas are difficult to treat and have a low probability of complete cure. The actual extent of the lesion must be carefully studied, and the indications for surgery must be strictly controlled.