Arteriovenous Malformations (AVMs): Causes, Symptoms, Diagnosis and Treatment

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Rare but potentially dangerous arterial anomalies, Arteriovenous Malformations (AVMs) can impact the brain, spine, or other body organs. Many people don’t know they have an AVM until symptoms start to show up. Patients can seek prompt medical attention and avoid difficulties by being aware of Arteriovenous Malformations, what they are, why they happen, and how to manage them.

For patients and carers, this guide provides a straightforward explanation of Arteriovenous Malformations.

An Arteriovenous Malformation: What Is It?

An unusual tangle of blood vessels where arteries join directly to veins without the typical network of small capillaries in between is known as an Arteriovenous Malformation (AVM).

Typical blood flow

The heart’s oxygen-rich blood is transported by arteries.
Capillaries facilitate the exchange of oxygen while slowing blood flow.
Blood is returned to the heart via the veins.

Brain blood flow comparison_ normal vs AVM

Within AVM

Veins and arteries are directly connected.
Blood moves too quickly.
Tissues nearby might not receive adequate oxygen.
Vessel walls deteriorate and are more likely to burst.

Because it can result in brain haemorrhage, the most serious kind is Brain AVM (cerebral AVM).

Arteriovenous Malformation Types

AVMs can develop in several body areas, including:

1. AVM of the brain (cerebral AVM)

Most prevalent and most hazardous
May result in brain haemorrhage or stroke.
May result in seizures.

2. AVM in the spine

Takes place within or around the spinal cord.
May result in paralysis or weakness.
Can have an impact on bowel and bladder control.

3. AVM in the periphery

Takes place in the lungs, limbs, or other organs.
May result in skin changes, discomfort, or swelling.

Cerebral angiography showing AVM details

Arteriovenous Malformation Causes

AVMs are typically:

Congenital, meaning it exists from birth
Grow when the foetal blood vessels are forming.
Not typically inherited

Uncommon genetic correlations

AVM risk is increased by certain circumstances, including:
Hemorrhagic telangiectasia inherited (HHT)
Important: A lot of patients have no known cause.
AVM Symptoms

The location and size of the AVM determine the symptoms.

Typical AVM Symptoms in the Brain

A sudden, intense headache
Seizures
Arm or leg weakness
Speaking difficulties
Vision issues
Feeling numb or tingly
Issues with balance

AVM Rupture Warning Signs (Medical Emergency)

The “worst headache of life” all at once
Throwing up
Unconsciousness
Abrupt neurological impairment

If any of these happen, get emergency care right away.

Arteriovenous Malformation Complications

AVMs can cause major issues if left untreated:

Brain haemorrhage, or brain bleeding
A stroke
Progressively worsening neurological impairments
Prolonged headaches
Disorders of seizures
Burden on the heart (in large AVMs)

The most severe consequence is brain haemorrhage.

How Do They Diagnose AVMs?

Results are greatly improved by early diagnosis.

1. CT scan

Rapid identification of cerebral haemorrhage
In an emergency, the initial test is frequently

2. Brain MRI

An in-depth look into the AVM structure
Aids in the planning of treatment

3. CT Angiography (CTA)

Displays the anatomy of blood vessels.

4. The Gold Standard of Digital Subtraction Angiography (DSA)

The most accurate test
Maps that show veins draining and arteries feeding
Necessary prior to therapy

Spetzler-Martin Grading or AVM Grading

In order to evaluate surgical risk, doctors grade brain AVMs according to:

The AVM’s size
Where in the brain
Pattern of venous drainage

Grades I through V are available:

Grade I–II: Reduced risk of surgery
Grade III: Moderate danger
Grade IV–V: Higher risk; frequently treated with radiosurgery or conservative measures

Related Post: Draining Vein Shielding During Gamma Knife Radiosurgery in Intracranial Arteriovenous Malformations

Arteriovenous Malformation Treatment

Each patient receives individualised treatment. Not every AVM needs surgery right away.

Factors Influencing the Choice of Treatment

Age of the patient
AVM placement and size
Bleeding history
Signs and symptoms
General well-being

1. Conservative Administration ( Important Observation )

Suggested when:

AVM is asymptomatic and tiny.
The danger of surgery is considerable.
The patient is elderly.

Consists of:

Frequent follow-up MRI
Medication for seizure control
Control of blood pressure

2. AVM Surgery, or Microsurgical Removal

For many accessible brain AVMs, this is the best choice.

Benefits

Cure right away if totally removed
Reduces the chance of bleeding in the future

When advised:

Poor quality AVMs
Previous bleeding
A site that is easily accessible

3. Embolisation of the Endovascular

A minimally invasive technique in which medical professionals:

Put a catheter into your groin.
To plug aberrant vessels, inject a substance that resembles glue.

Opportunities

Frequently carried out prior to surgery
Occasionally, when used alone
Decreases blood flow and AVM size

4. Gamma Knife stereotactic radiosurgery

Gradually closes the AVM using concentrated radiation.

Ideal for:

AVMs that are little to medium
High-risk or deep surgical sites

Critical information:

Two to three years are needed for total obliteration.
There is still a slight chance of bleeding at this time.

Rehabilitation Following AVM Therapy

The sort of treatment determines recovery.

Following Surgery

Typical length of hospital stay: 3–7 days
Gradual return to regular activities
Imaging follow-up is necessary.

Following Radiosurgery

Typically, outpatient
Frequent follow-up MRI
AVM closure over time, gradually

Rehabilitation could consist of:

Physical therapy
Speech therapy
Management of seizures

When Is the Right Time to See a Neurosurgeon?

Seek advice from an expert if you encounter:

Unknown seizures
Frequent, intense headaches
Unexpected neurological symptoms
Unexpected AVM discovered during scan
Vascular malformations in the family history

Early professional assessment can save lives.

Lifestyle Advice for People Living With an AVM

Individuals with an AVM diagnosis should:

Keep your blood pressure under control.
Don’t smoke.
Avoid drinking too much alcohol.
Regularly use anti-seizure medications, if prescribed.
Attend the follow-ups as planned.
Seek emergency attention if you have a sudden, intense headache.

Important Takeaways

An aberrant artery-vein connection is known as an Arteriovenous Malformation.
Brain AVMs may result in convulsions, stroke, or bleeding.
Many AVMs are identified by accident and are congenital.
The gold standard for diagnosis is Digital Subtraction Angiography (DSA).
Surgery, embolisation, radiosurgery, and observation are available treatment options.
Results are considerably improved by early specialist review.

FAQ’s

1. Is AVM a tumour of the brain?

No, a tumour is not an AVM. It is an irregular blood vascular connection.

2. Can AVM disappear by itself?

Very infrequently. The majority of AVMs are persistent and need to be treated or monitored.

3. What is the chance of rupturing an AVM?

Generally speaking:
2-4% annually for cerebral AVMs
If it has already bled, the risk is increased.

4. Does AVM run in families?

Generally speaking, no. The majority of AVMs happen infrequently. The proportion associated with hereditary diseases such as HHT is quite low.

5. Is it possible to heal AVM?

Indeed, a lot of AVMs can be fully healed using:
Microsurgery
Radiosurgery
or a combination of therapies

The location and AVM grade determine the outcome.

6. How risky is AVM surgery?

There are hazards, just like with any brain operation. However, surgery can be extremely safe and curative in skilled hands and in circumstances that are carefully chosen.

7. Can seizures be brought on by AVM?

Indeed, one of the most typical initial signs of brain AVM is seizures.

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