Arteriovenous malformations have a wide range of clinical presentations and an unfortunately unpredictable response to both nonsurgical and surgical intervention. The authors report on the surgical treatment of a 19-year-old man with a complex lower extremity arteriovenous malformation, previously unsuccessfully treated with numerous local sclerotherapy and interventional radiology embolization procedures leading to massive tissue necrosis and deep infection. The patient was definitively treated with wide excision of the necrotic tissue, coils, and arteriovenous malformation, but with preservation of the tibial nerve and vascular supply to the foot. Significant postoperative complications were prevented with the use of a novel dynamic compression device employing peristaltic pulse pneumatic compression.