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| {{SK}} AVM; arterio-venous malformations; arteriovenous malformations | | {{SK}} AVM; arterio-venous malformations; arteriovenous malformations |
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| ==Overview==
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| | {{CMG}}; {{AE}} {{CZ}}; {{ADI}} |
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| ==Pathophysiology==
| | {{SK}} Arteriovenous malformations of liver; hepatic fibrosis; hepatic sclerosis |
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| Arteries and veins are part of the [[Circulatory system|human cardiovascular system]]. Normally, the arteries in the vascular system carry oxygen-rich blood at a relatively high pressure. 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 from the surrounding cells. Capillaries successively join together, one upon the other, to form the veins that carry blood away at a relatively low pressure. The heart acts to pump blood from the low pressure veins to the high pressure arteries.
| | == [[Arteriovenous malformations overview|Overview]] == |
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| If the capillary bed is thought of as a sponge, then an AVM is the rough equivalent of inserting a tangle of drinking straw|flexible soda straws from artery to vein through that sponge. On an arteriogram, an AVM often resemble a tangle of spaghetti noodles. This tangle of blood vessels forms a relatively direct connection between high pressure arteries and low pressure veins and bypasses the capillary bed.
| | == [[Arteriovenous malformations historical perspective|Historical Perspective]] == |
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| The result is a collection of blood vessels with abnormal connections and no [[Capillary|capillaries]]. This collection, often called a ''nidus'', can be extremely fragile and prone to bleeding. This bleeding can be catastrophic if it occurs in the brain, the lung or the gastrointestinal tract.
| | == [[Arteriovenous malformations classification|Classification]] == |
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| AVMs can occur in various parts of the body
| | == [[Arteriovenous malformations pathophysiology|Pathophysiology]] == |
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| * [[human brain|Brain]], causing a [[cerebral arteriovenous malformation]]
| | == [[Arteriovenous malformations causes|Causes]] == |
| * [[Spleen]]<ref name="pmid17145440">{{cite journal |author=Agrawal A, Whitehouse R, Johnson RW, Augustine T |title=Giant splenic artery aneurysm associated with arteriovenous malformation |journal=J. Vasc. Surg. |volume=44 |issue=6 |pages=1345–9 |year=2006|month=December |pmid=17145440 |doi=10.1016/j.jvs.2006.06.049|url=http://linkinghub.elsevier.com/retrieve/pii/S0741-5214(06)01369-3 |accessdate=2008-06-01}}</ref>
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| * [[Lung]]<ref name="pmid18294908">{{cite journal |author=Chowdhury UK, Kothari SS, Bishnoi AK, Gupta R, Mittal CM, Reddy S|title=Successful Lobectomy for Pulmonary Arteriovenous Malformation Causing Recurrent Massive Haemoptysis |journal=Heart Lung Circ |volume= |issue= |pages= |year=2008 |month=February |pmid=18294908 |doi=10.1016/j.hlc.2007.11.142|url=http://linkinghub.elsevier.com/retrieve/pii/S1443-9506(07)01113-4 |accessdate=2008-06-01}}</ref>
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| * [[Kidney]]<ref name="pmid16794894">{{cite journal |author=Barley FL, Kessel D, Nicholson T, Robertson I |title=Selective embolization of large symptomatic iatrogenic renal transplant arteriovenous fistula |journal=Cardiovasc Intervent Radiol|volume=29 |issue=6 |pages=1084–7 |year=2006 |pmid=16794894 |doi=10.1007/s00270-005-0265-z}}</ref>
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| * [[Spinal cord]]<ref name="pmid15730991">{{cite journal |author=Kishi K, Shirai S, Sonomura T, Sato M |title=Selective conformal radiotherapy for arteriovenous malformation involving the spinal cord |journal=Br J Radiol |volume=78 |issue=927 |pages=252–4|year=2005 |month=March |pmid=15730991 |doi= |url=http://bjr.birjournals.org/cgi/pmidlookup?view=long&pmid=15730991}}</ref>
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| * [[Liver]]<ref name="pmid7650340">{{cite journal |author=Bauer T, Britton P, Lomas D, Wight DG, Friend PJ, Alexander GJ|title=Liver transplantation for hepatic arteriovenous malformation in hereditary haemorrhagic telangiectasia |journal=J. Hepatol. |volume=22 |issue=5 |pages=586–90 |year=1995 |month=May |pmid=7650340 |doi=|url=http://linkinghub.elsevier.com/retrieve/pii/0168-8278(95)80455-2 |accessdate=2008-06-01}}</ref>
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| * [[Intercostal space]]<ref name="pmid17056881">{{cite journal |author=Rivera PP, Kole MK, Pelz DM, Gulka IB, McKenzie FN, Lownie SP |title=Congenital intercostal arteriovenous malformation |journal=AJR Am J Roentgenol |volume=187 |issue=5 |pages=W503–6|year=2006 |month=November |pmid=17056881 |doi=10.2214/AJR.05.0367 |url=http://www.ajronline.org/cgi/pmidlookup?view=long&pmid=17056881}}</ref>
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| * [[Iris (anatomy)|Iris]]<ref name="pmid16534057">{{cite journal |author=Shields JA, Streicher TF, Spirkova JH, Stubna M, Shields CL |title=Arteriovenous malformation of the iris in 14 cases |journal=Arch. Ophthalmol. |volume=124 |issue=3 |pages=370–5|year=2006 |month=March |pmid=16534057 |doi=10.1001/archopht.124.3.370 |url=http://archopht.ama-assn.org/cgi/pmidlookup?view=long&pmid=16534057}}</ref>
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| * [[Spermatic cord]]<ref name="pmid17939869">{{cite journal |author=Sountoulides P, Bantis A, Asouhidou I, Aggelonidou H|title=Arteriovenous malformation of the spermatic cord as the cause of acute scrotal pain: a case report |journal=J Med Case Reports |volume=1 |issue= |pages=110 |year=2007 |pmid=17939869 |doi=10.1186/1752-1947-1-110|url=http://www.jmedicalcasereports.com/content/1//110}}</ref>
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| === Genetics ===
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| Can occur due to autosomal dominant diseases, such as Hereditary Hemorrhagic Telangiectasia
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| == Epidemiology and Demographics== | | == [[Arteriovenous malformations differential diagnosis|Differentiating Arteriovenous malformations from other Diseases]] == |
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| An estimated 300,000 Americans have AVMs, of which 12% (approximately 36,000) will exhibit symptoms that differ greatly in severity.
| | == [[Arteriovenous malformations epidemiology and demographics|Epidemiology and Demographics]] == |
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| ==Diagnosis== | | == [[Arteriovenous malformations risk factors|Risk Factors]] == |
| ===Symptoms ===
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| Symptoms of AVM vary according to the location of the malformation. Roughly (88% -needs citation) 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), rarely its expansion or a micro-bleed from it, could cause epilepsy, deficit or elicit pain.
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| The most general symptoms include
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| * [[Headache]]
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| * [[Epilepsy]],
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| * Difficulties with movement or coordination, including [[muscle weakness]] and even [[paralysis]];
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| * [[Vertigo (medical)|vertigo]] (dizziness);
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| * Difficulties of speech ([[dysarthria]]) and communication, such as [[alogia]];
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| * Difficulties with everyday activities, such as [[apraxia]];
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| * Abnormal sensations (numbness, tingling, or spontaneous [[pain]]);
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| * Memory and thought-related problems, such as [[confusion]], [[dementia]] or [[hallucination]]s.
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| '''Patient #1: MRI demonstrates a large right AVM'''
| | == [[Arteriovenous malformations natural history|Natural History, Complications and Prognosis]] == |
| <gallery>
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| Image:
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| Arteriovenous malformation001.jpg|T2
| | == Diagnosis == |
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| Image:
| | [[Arteriovenous malformations symptoms|History and Symptoms]] | [[Arteriovenous malformations physical examination|Physical Examination]] | [[Arteriovenous malformations laboratory tests|Laboratory Findings]] | [[Arteriovenous malformations electrocardiogram|Electrocardiogram]] | [[Arteriovenous malformations chest x ray|Chest X Ray]] | [[Arteriovenous malformations endoscopy|Endoscopy]] | [[Arteriovenous malformations CT|CT]] | [[Arteriovenous malformations MRI|MRI]] | [[Arteriovenous malformations echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Arteriovenous malformations other imaging findings|Other Imaging Findings]] | [[Arteriovenous malformations other diagnostic studies|Other Diagnostic Studies]] |
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| Arteriovenous malformation002.jpg|T2
| | == Treatment == |
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| | [[Arteriovenous malformations medical therapy|Medical Therapy]] | [[Arteriovenous malformations surgery|Surgery]] | [[Arteriovenous malformations primary prevention|Primary Prevention]] | [[Arteriovenous malformations secondary prevention|Secondary Prevention]] | [[Arteriovenous malformations tertiary prevention|Tertiary Prevention]] | [[Arteriovenous malformations cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Arteriovenous malformations future or investigational therapies|Future or Investigational Therapies]] |
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| Arteriovenous malformation003.jpg|FLAIR
| | ==Case Studies== |
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| Arteriovenous malformation004.jpg|GRE
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| Arteriovenous malformation005.jpg|T1 with GAD
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| Image:
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| Arteriovenous malformation006.jpg|T1 with GAD
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| Image:
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| Arteriovenous malformation007.jpg|T1 with GAD
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| Arteriovenous malformation008.jpg|T1 with GAD
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| </gallery>
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| == Treatment ==
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| Treatment can be symptomatic, or it can involve surgery or radiation therapy.
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| It can also be carried out via in interventinal radiography procedure using a glue to cut off the blood supply to the AVM.
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| == Research directions ==
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| The optimal management of AVMs remains an ongiong topic of clinical research. <ref>[http://www.cliniclog.com/arterio-venous_malformations.php Research trials in arterio-venous malformations; Rustam Al-Shahi Salman]</ref>.
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| ==References==
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| {{reflist|2}}
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Neurology]] | | [[Category:Neurology]] |
| [[Category:Needs patient information]]
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| [[Category:Disease]] | | [[Category:Disease]] |
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