Arteriovenous Malformation
Most arteriovenous malformations (AVMs) are asymptomatic with about 10 to 15 percent of the total AVMs causing life-threatening symptoms.

If the arteriovenous malformation (AVM) is large enough to upset the organ perfusion, the surrounding tissues may not get sufficient oxygen. An AVM may bleed inside an organ where it is present.

  • If present over the face or neck, it is an aesthetic concern.
  • If present inside a muscle, it may cause severe pain, muscle death, and disability if it ruptures.
  • If present in the brain it may bleed and cause stroke, hemorrhage, or even death.

An AVM may increase in size during puberty, pregnancy, or (rarely) a blunt trauma and cause other complications. Most AVMs are asymptomatic with only 10 to 15 percent of the total AVMs causing life-threatening symptoms or complications.

The circulatory system consists of the heart and other blood vessels. There are three kinds of blood vessels in the circulatory framework: veins, capillaries, and arteries. Arteries are responsible for taking oxygen-rich blood from the heart to the body. Veins carry the oxygen-depleted blood back to the lungs and heart from the body.

The arteries divide into arterioles, then into capillaries, which connect to the venules, eventually forming veins. This area, where the arterioles and venules interconnect, is called the arteriovenous junction. Any defect in this area is called AVM, which can occur anywhere in the body, but the most symptomatic cases are reported in the head, neck, face region, and spine.

What causes arteriovenous malformation?

The causes of arteriovenous malformations (AVMs) are unknown. A few specialists accept that they happen in the womb or not long after birth and show up later as the kid ages. Some cases of AVM could be hereditary. Hereditary hemorrhagic telangiectasia and PTEN and RASA1 mutations increase the chances of AVMs.

What are the signs and symptoms of arteriovenous malformation?

About 12 percent of arteriovenous malformations (AVMs) are symptomatic, while others could only be found incidentally during an autopsy for other causes. Because the most common location of AVM is the brain, many individuals complain of symptoms related to the central nervous systems.

Sometimes, the person with AVMs presents as a case of stroke or paralysis due to bleeding from the site of AVMs. Other symptoms include:

Rare possible signs and symptoms

How is arteriovenous malformation diagnosed?

The doctor will conduct a physical examination and few tests to affirm an arteriovenous malformation (AVM).

Imaging instruments used to analyze AVMs include:

  • A computed tomography scan produces definite pictures of the insides of the body.
  • Angiography visualizes the veins around the head and neck by infusing color through a catheter (which is typically embedded through a vein in the groin).
  • A magnetic resonance angiogram produces pictures of the veins.

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What is the treatment of arteriovenous malformation?

The treatment plan for arteriovenous malformations (AVMs) will depend on the age, condition, and comorbidities of the patient. The main objective is to prevent internal bleeding, which can prompt stroke or death.

  • Medications: The doctor may prescribe medicines even though they do not cure AVMs. Drugs control pain, limit brain edema and seizures.
  • Medical procedures: These depend on the type of AVM the patient is suffering from. If the AVM does not cause any problems, the doctor may recommend a wait and watch approach. In other cases, the following modalities of treatment are available:
    • Endovascular embolization: Endovascular embolization is utilized for AVMs in the cerebrum or spinal cord tissue. In this strategy, a slight, adaptable cylindrical tube (catheter) is directed to the AVM. Special metal coils, plugs, or glues are inserted into the center of the AVM through the catheter to close the abnormal connection. It does not fix the AVM, but it decreases blood supply in the AVM, reducing the risk of bleeds or ruptures in the future.
    • Radiosurgery: Radiosurgery utilizes light emission at the site of the AVM. Such radiation produces scar tissue, which will eventually help reduce the size of the AVM.
    • Conventional surgery: Surgery to fix or remove affected veins is an option. However, it may not always be a feasible option.

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Medically Reviewed on 9/22/2021
References
Sen S. Arteriovenous Malformations. Medscape. https://emedicine.medscape.com/article/1160167-overview

Speer AL. Vascular Surgery for Arteriovenous Malformations. Medscape. https://emedicine.medscape.com/article/459927-overview