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Arteriovenous malformation

 Arteriovenous malformation



Overview

An arteriovenous malformation, also known as an AVM, is a tangle of blood vessels that creates irregular connections between arteries and veins. This disrupts blood flow and prevents tissues from receiving oxygen. An AVM can occur anywhere in the body, including in the brain.

Arteries move oxygen-rich blood from the heart to the brain and other organs. Veins drain the oxygen-depleted blood back to the lungs and heart. When an AVM disrupts this critical process, surrounding tissues might not get enough oxygen.

Because the tangled blood vessels in an AVM do not form properly, they can weaken and burst. If an AVM in the brain bursts, it can cause bleeding in the brain, which can lead to a stroke or brain damage. Bleeding in the brain is known as a hemorrhage.

Types of AVMs

The two types of AVMs are:

Brain arteriovenous malformations. These develop anywhere within your brain tissue or on the surface of your brain. AVMs most commonly occur in your brain, brainstem and spinal cord.

Peripheral arteriovenous malformations. These can form anywhere in your body’s 100,000 miles of blood vessels. They can happen on your face, arms or legs, and in tissues and organs like your heart, liver or lungs.

Symptoms

Symptoms of an arteriovenous malformation, also known as an AVM, can vary. Sometimes an AVM doesn't cause symptoms. The AVM can be found while getting images for another health concern.

Often the first symptoms appear after bleeding occurs. Besides bleeding, symptoms can include:

Trouble with thinking that gets worse over time.

Headaches.

Nausea and vomiting.

Seizures.

Loss of consciousness.

Other possible symptoms include:

Weak muscles, such as weakness in the legs.

Loss of movement and feeling in one part of the body, known as paralysis.

Loss of coordination that can cause trouble with walking.

Trouble doing tasks that require planning.

Back pain.

Dizziness.

Vision problems. This may include losing part of the field of vision, trouble moving the eyes or swelling of part of the optic nerve.

Trouble with speech or understanding language.

Numbness, tingling or sudden pain.

Memory loss or dementia.

Seeing or hearing things that aren't there, known as hallucinations.

Confusion.

Children and teens might have trouble with learning or behavior.

One type of AVM called a vein of Galen malformation causes symptoms that appear at or shortly after birth. A vein of Galen malformation occurs deep inside the brain. Signs can include:

A buildup of fluid in the brain that causes the head to be larger than usual.

Swollen veins on the scalp.

Seizures.

Failure to thrive.

Congestive heart failure.

Causes

An arteriovenous malformation happens when arteries and veins connect in an irregular way. Experts don't understand why this happens. Certain genetic changes might play a role, but most types are not usually passed down in families.

Risk factors

Rarely, having a family history of an arteriovenous malformation can increase your risk. But most types aren't inherited.

Certain hereditary conditions can increase your risk of an arteriovenous malformation. These include hereditary hemorrhagic telangiectasia, also known as Osler-Weber-Rendu syndrome.

Complications

Complications of brain AVMs include:

Brain bleed/stroke. This is the biggest risk of having an AVM. A bleed from an AVM in your brain causes a stroke, brain damage or seizures. AVMs in these enclosed areas can also press on and displace parts of your brain and spinal cord.

Seizures. This rush of electrical activity in your brain can lead to passing out and having muscle movements you can’t control.

Aneurysm. This is a balloon-like bulge in the walls of any of the blood vessels feeding into or around the AVM. They develop because of weakness in your blood vessel walls. Aneurysms develop in about 50% of all brain and spinal cord AVMs. AVM-related aneurysms can increase your risk of rupture (bleeding) and bleeding-related symptoms.

Brain damage that affects thinking, mental processing, memory or understanding speech.

Coma and death, especially from a large bleed in your brain.

Diagnosis

To diagnose an arteriovenous malformation, also known as an AVM, your healthcare professional reviews your symptoms and gives you a physical exam.

Your healthcare professional may listen for a sound called a bruit. A bruit is a whooshing sound caused by blood quickly flowing through arteries and veins of an AVM. It sounds like water rushing through a narrow pipe. A bruit can interfere with your hearing or sleep or cause emotional distress.

Tests commonly used to help diagnose AVM include:

Cerebral angiography. This test looks for an AVM in the brain. Also called arteriography, this test uses a special dye called a contrast agent injected into an artery. The dye highlights the blood vessels to better show them on X-rays.

CT scan. These scans can help show bleeding. CT scans use X-rays to create images of the head, brain or spinal cord.

CT angiography. This test combines a CT scan with an injection of a dye to help find an AVM that is bleeding.

MRI. An MRI uses powerful magnets and radio waves to show detailed images of tissues. An MRI can pick up on small changes in these tissues.

Magnetic resonance angiography, also known as an MRA. MRA captures the pattern and the speed and distance of blood flow through the irregular vessels.

Transcranial doppler ultrasound. This test can help diagnose an AVM and tell whether the AVM is bleeding. The test uses high-frequency sound waves aimed at arteries to create an image of blood flow and its speed.

Arteriovenous malformation treatment choices depend on:

The AVM’s type, size and location, and the anatomy of your arteries and veins.

Risk of AVM rupture.

Your symptoms.

Your age.

Your general health.

Ideally, the goal of arteriovenous malformation treatment is to reduce the chance of bleeding or make it permanently go away. There are several different ways to treat it. These treatment types include open surgery, catheter-based artery blocking, and/or focused radiation to the AVM. Any type of intervention has benefits and risks that depend your overall health and the characteristics of your AVM.

In general, treating an arteriovenous malformation as soon as possible is usually the best way to avoid serious complications.

Each person — and each person’s AVM — is unique. There aren’t any perfect decision-making tools. Your healthcare team will talk to you and your family about your situation and the best way to approach your AVM.

An AVM might be in an area where the dangers of surgery or other treatments pose a greater risk than doing nothing. If this is the case, your healthcare team may carefully monitor your AVM with imaging tests over time. If the AVM begins showing signs of change, indicating an increased risk of bleeding, your provider may consider treatment at that time.

Medications

Medications can relieve some of the symptoms of AVMs. These include:

Anti-seizure medications.

Pain relievers for headache and back pain.

Blood pressure medications.

Procedures

Healthcare providers may try one or more of these approaches:

Surgery to remove the AVM. Surgery involves making a small cut near the AVM, sealing the surrounding arteries and veins so they don’t bleed, then removing the AVM. A surgeon redirects blood flow to normal blood vessels. Surgery is a cure for this condition. You’ll have a brain scan to make sure the surgery completely removed or destroyed the AVM. You’ll also have a short hospital stay (a few days) and undergo some short-term rehabilitation.

Embolization. In this procedure, a provider inserts a catheter into an artery in your groin or wrist and moves it to the location of the AVM. Once there, they release a glue-like substance, coils or another substance into the AVM, which slows or stops the blood flow through the AVM. Providers use this approach when the AVMs are large and have a lot of blood flowing through them. This way, they can remove them more easily with less risk of bleeding if they perform surgery immediately afterward. Embolization can also slow blood flow to reduce rupture if a surgeon doesn’t operate immediately.

Gamma Knife radiosurgery. This approach uses highly focused beams of radiation that slowly shrink, scar and dissolve an AVM over a few years or make the AVM easier to remove with surgery. You’ll have scans from time to time to see if the AVM is shrinking.

Complications of the treatment

Complications or side effects from arteriovenous malformation treatment may include:

Bleeding.

Headache.

Swelling.

Damage to nearby tissues.

Muscle weakness on one side.

Effects on speech, hearing or vision.

Results that aren’t complete, don’t last or take months to reach their full effect.

Serious complications that can be disabling or fatal.

Type of Doctor Department : Neurosurgeons, interventional radiologists, neurologists, and potentially vascular surgeons or radiation oncologists


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