Arteriovenous malformation

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See also: Cerebral arteriovenous malformation Arteriovenous malformation or AVM is an abnormal connection between veins and arteries, usually congenital. This pathology is widely known because of its occurrence in the central nervous system, but can appear in any location. The genetic transmission patterns of AVM, if any, are unknown. AVM is not generally thought to be an inherited disorder, unless in the context of a specific hereditary syndrome.

Arteriovenous malformation
Classification and external resources

Contents
1 Signs and symptoms 2 Pathophysiology 3 Diagnosis 4 Treatment 5 Epidemiology 6 Society and culture 7 Research directions 8 See also 9 References 10 External links

Micrograph of an arteriovenous malformation in the brain. HPS stain. ICD-10 Q27.3 (http://apps.who.int/classifications/apps/icd/icd10online/? gq20.htm+q273) , Q28.0 (http://apps.who.int/classifications/apps/icd/icd10online/? gq20.htm+q280) , Q28.2 (http://apps.who.int/classifications/apps/icd/icd10online/? gq20.htm+q282) ICD-9 747.6 (http://www.icd9data.com/getICD9Code.ashx? icd9=747.6) , 747.81 (http://www.icd9data.com/getICD9Code.ashx?icd9=747.81) DiseasesDB 15235 (http://www.diseasesdatabase.com/ddb15235.htm)

Signs and symptoms

Symptoms of AVM vary according to the location of the malformation. Roughly 88% [1] of people affected with AVM are asymptomatic; often the malformation is discovered as part of an autopsy or during treatment of an unrelated disorder (called in medicine "an incidental finding"); in rare cases its expansion or a micro-bleed from an AVM in the brain can cause epilepsy, deficit or pain.

MedlinePlus 000779 (http://www.nlm.nih.gov/medlineplus/ency/article/000779.htm) eMedicine topic list (http://search.medscape.com/emedicine-search? queryText=Arteriovenous%20Malformation) MeSH D001165 (http://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi? field=uid&term=D001165)

The most general symptoms of a cerebral AVM include headache and epilepsy, with more specific symptoms occurring that normally depend on the location of the malformation and the individual. Such possible symptoms include:[2]
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Difficulties with movement or coordination, including muscle weakness and even paralysis; vertigo (dizziness); Difficulties of speech (dysarthria) and communication, such as aphasia; Difficulties with everyday activities, such as apraxia; Abnormal sensations (numbness, tingling, or spontaneous pain); Memory and thought-related problems, such as confusion, dementia or hallucinations.

Pathophysiology

Arteriovenous malformations, also known as AVMs, are deficiencies of the cardiovascular system. In a normal functioning human body, arteries carry oxygen-rich blood away from the heart to the rest of the body, and veins return oxygen-depleted blood to the lungs and heart. An AVM interferes with this cyclical process. Instead of the gradual transition through the capillaries from arteries to veins that is typical of normal functioning vasculature, AVMs cause direct associations of the arteries and veins. AVMs can cause intense pain and lead to serious medical problems. Although AVMs are often associated with the brain and spinal cord, they can develop in any part of the body. Arteries and veins are part of the human cardiovascular system. Normally, the arteries in the vascular system carry oxygen-rich blood, except in the case of the pulmonary artery. Structurally, arteries divide and sub-divide repeatedly, eventually forming a sponge-like capillary bed. Blood moves through the capillaries, giving up oxygen and taking up waste products, including CO2, from the surrounding cells. Capillaries in turn successively join together to form veins that carry blood away. The heart acts to pump blood through arteries and uptake the venous blood. An AVM lacks the dampening effect of capillaries on the blood flow; it also causes the surrounding area to be deprived of the functions of the capillaries - removal of CO2 and delivery of nutrients to the cells. The resulting tangle of blood vessels, often called a nidus (Latin for "nest") has no capillaries and abnormally direct connections between high-pressure arteries and low-pressure veins. It can be extremely fragile and prone to bleeding. The resultant sign, audible via stethoscope, is a rhythmic, whooshing sound caused by excessively rapid blood flow through the arteries and veins. It has been given the term "bruit", French for noise. On some occasions a patient with a brain AVM may become aware of the noise, which can compromise hearing and interfere with sleep in addition to causing psychological distress.

Diagnosis
AVMs can occur in various parts of the body: brain, causing a cerebral arteriovenous malformation spleen[3] lung[4] kidney[5] spinal cord[6] liver[7] intercostal space[8] iris[9] spermatic cord[10] AVMs may occur in isolation or as a part of another disease (for example, Von Hippel-Lindau disease or hereditary hemorrhagic telangiectasia). AVMs have been shown to be associated with Aortic Stenosis.[11] Bleeding from an AVM can be devastating, particularly in the brain. It can cause severe and often fatal strokes. If a cerebral AVM is detected before a stroke occurs, usually the arteries feeding blood into the nidus can be closed off to avert the danger.

An aterial venous malformation of the left kidney and a simple cyst of the right kidney

Treatment
Treatment can be symptomatic, or it can involve surgery or radiation therapy.[2] Embolization, that is, cutting off the blood supply to the AVM with coils or particles or glue introduced by a radiographically guided catheter, can be used in addition to either, but is rarely successful in isolation except for in smaller AVMs.
An aterial venous malformation of the left kidney leading to aneurysmal dilatation of the left renal vein and inferior vena cava

Epidemiology

An estimated 300,000 Americans have AVMs, of whom 12% (approximately 36,000) will exhibit symptoms of greatly varying severity.[2]

Society and culture

On December 13, 2006, Senator Tim Johnson was diagnosed with AVM and treated at George Washington University Hospital.[12] On August 3, 2011, Mike Patterson of the Philadelphia Eagles collapsed on the field and suffered a seizure during a practice. After he collapsed, Patterson was rushed to the hospital where he quickly texted Eagles employees and teammates that he was fine. He was described as alert and stable in the hospital, where he stayed overnight. Patterson was diagnosed with AVM on August 4.[13]

Research directions
Despite many years of research, the central question of whether to treat AVMs has not been answered. All treatments, whether involving surgery, radiation, or drugs, have risks and side-effects. Therefore it might be better in some cases to avoid treatment altogether and simply accept a small risk of coming to harm from the AVM itself. This question is currently being addressed in clinical trials.[14]

See also
Foix-Alajouanine syndrome

References
1. ^ National Institute of Neurological Disorders and Stroke (http://www.ninds.nih.gov/disorders/avms/detail_avms.htm#102083052) 2. ^ a b c Arteriovenous Malformation Information Page (http://www.ninds.nih.gov/disorders/avms) at NINDS 3. ^ Agrawal A, Whitehouse R, Johnson RW, Augustine T (December 2006). "Giant splenic artery aneurysm associated with arteriovenous malformation" (http://linkinghub.elsevier.com/retrieve/pii/S0741-5214(06)01369-3) . J. Vasc. Surg. 44 (6): 13459. doi:10.1016/j.jvs.2006.06.049 (http://dx.doi.org/10.1016%2Fj.jvs.2006.06.049) . PMID 17145440 (http://www.ncbi.nlm.nih.gov/pubmed/17145440) . http://linkinghub.elsevier.com/retrieve/pii/S0741-5214(06)01369-3. Retrieved 2008-0601. 4. ^ Chowdhury UK, Kothari SS, Bishnoi AK, Gupta R, Mittal CM, Reddy S (February 2008). "Successful Lobectomy for Pulmonary Arteriovenous Malformation Causing Recurrent Massive Haemoptysis" (http://linkinghub.elsevier.com/retrieve/pii/S1443-9506(07)01113-4) . Heart Lung Circ 18 (2): 1359. doi:10.1016/j.hlc.2007.11.142 (http://dx.doi.org/10.1016%2Fj.hlc.2007.11.142) . PMID 18294908 (http://www.ncbi.nlm.nih.gov/pubmed/18294908) . http://linkinghub.elsevier.com/retrieve/pii/S1443-9506(07)01113-4. Retrieved 2008-0601. 5. ^ Barley FL, Kessel D, Nicholson T, Robertson I (2006). "Selective embolization of large symptomatic iatrogenic renal transplant arteriovenous fistula". Cardiovasc Intervent Radiol 29 (6): 10847. doi:10.1007/s00270-005-0265-z (http://dx.doi.org/10.1007%2Fs00270005-0265-z) . PMID 16794894 (http://www.ncbi.nlm.nih.gov/pubmed/16794894) . 6. ^ Kishi K, Shirai S, Sonomura T, Sato M (March 2005). "Selective conformal radiotherapy for arteriovenous malformation involving the spinal cord" (http://bjr.birjournals.org/cgi/pmidlookup?view=long&pmid=15730991) . Br J Radiol 78 (927): 2524. doi:10.1259/bjr/50653404 (http://dx.doi.org/10.1259%2Fbjr%2F50653404) . PMID 15730991 (http://www.ncbi.nlm.nih.gov/pubmed/15730991) . http://bjr.birjournals.org/cgi/pmidlookup?view=long&pmid=15730991. 7. ^ Bauer T, Britton P, Lomas D, Wight DG, Friend PJ, Alexander GJ (May 1995). "Liver transplantation for hepatic arteriovenous malformation in hereditary haemorrhagic telangiectasia" (http://linkinghub.elsevier.com/retrieve/pii/0168-8278(95)80455-2) . J. Hepatol. 22 (5): 58690. doi:10.1016/0168-8278(95)80455-2 (http://dx.doi.org/10.1016%2F0168-8278%2895%2980455-2) . PMID 7650340 (http://www.ncbi.nlm.nih.gov/pubmed/7650340) . http://linkinghub.elsevier.com/retrieve/pii/0168-8278(95)80455-2. Retrieved 2008-06-01. 8. ^ Rivera PP, Kole MK, Pelz DM, Gulka IB, McKenzie FN, Lownie SP (November 2006). "Congenital intercostal arteriovenous malformation" (http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=17056881) . AJR Am J Roentgenol 187 (5): W5036. doi:10.2214/AJR.05.0367 (http://dx.doi.org/10.2214%2FAJR.05.0367) . PMID 17056881 (http://www.ncbi.nlm.nih.gov/pubmed/17056881) . http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=17056881. 9. ^ Shields JA, Streicher TF, Spirkova JH, Stubna M, Shields CL (March 2006). "Arteriovenous malformation of the iris in 14 cases" (http://archopht.ama-assn.org/cgi/pmidlookup?view=long&pmid=16534057) . Arch. Ophthalmol. 124 (3): 3705. doi:10.1001/archopht.124.3.370 (http://dx.doi.org/10.1001%2Farchopht.124.3.370) . PMID 16534057

(http://www.ncbi.nlm.nih.gov/pubmed/16534057) . http://archopht.ama-assn.org/cgi/pmidlookup?view=long&pmid=16534057. 10. ^ Sountoulides P, Bantis A, Asouhidou I, Aggelonidou H (2007). "Arteriovenous malformation of the spermatic cord as the cause of acute scrotal pain: a case report" (http://www.jmedicalcasereports.com/content/1//110) . J Med Case Reports 1: 110. doi:10.1186/1752-1947-1110 (http://dx.doi.org/10.1186%2F1752-1947-1-110) . PMC 2194703 (http://www.pubmedcentral.gov/articlerender.fcgi? tool=pmcentrez&artid=2194703) . PMID 17939869 (http://www.ncbi.nlm.nih.gov/pubmed/17939869) . http://www.jmedicalcasereports.com/content/1//110. 11. ^ . PMID 12912718 (http://www.ncbi.nlm.nih.gov/pubmed/12912718) . 12. ^ "Sen. Johnson recovering after brain surgery" (http://www.msnbc.msn.com/id/16199440/) , AP, December 14, 2006. 13. ^ "Mike Patterson's Collapse Reportedly Related To Brain AVM" (http://www.sbnation.com/2011/8/4/2343821/mike-patterson-collapseeagles-practice) 14. ^ Research trials in arterio-venous malformations; Rustam Al-Shahi Salman (http://www.cliniclog.com/arterio-venous_malformations.php)

External links
AVM Support Groups (http://www.dmoz.org/Health/Conditions_and_Diseases/Neurological_Disorders/Stroke/Support_Groups/Chats_and_Forums/) from the DMOZ Open Directory. University of California San Francisco AVM research. (http://avm.ucsf.edu) Retrieved from "http://en.wikipedia.org/wiki/Arteriovenous_malformation" Categories: Congenital vascular defects | Gross pathology This page was last modified on 22 August 2011 at 15:43. Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. See Terms of use for details. Wikipedia is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization.