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| | __NOTOC__ |
| {{Infobox_Disease | | {{Infobox_Disease |
| | Name = {{PAGENAME}} | | | Name = {{PAGENAME}} |
| | Image = Cerebral arteriovenous malformation 1.jpeg | | | Image = Cerebral arteriovenous malformation 1.jpeg |
| | Caption = Brain: Arteriovenous Malformation: Gross fixed tissue close-up view of malformation in meninges and cerebral cortex (an excellent example). <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small> | | | Caption = Brain: Arteriovenous Malformation: Gross fixed tissue close-up view of malformation in meninges and cerebral cortex (an excellent example). <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small> |
| | DiseasesDB = 15235
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| | ICD10 = {{ICD10|Q|27|3|q|20}}, {{ICD10|Q|28|0|q|20}}, {{ICD10|Q|28|2|q|20}}
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| | ICD9 = {{ICD9|747.6}}, {{ICD9|747.81}}
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| | ICDO =
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| | MedlinePlus =
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| | eMedicineSubj = med
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| | eMedicineTopic = 169
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| | eMedicine_mult = {{eMedicine2|med|170}} {{eMedicine2|neuro|21}}
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| | MeshID = D001165
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| }} | | }} |
| {{SI}} | | {{Arteriovenous malformations}} |
| {{WikiDoc Cardiology Network Infobox}}
| | '''For patient information click [[Arteriovenous malformations (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}}; {{AE}} {{KD}} |
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| {{Editor Help}} | | {{SK}} AVM; arterio-venous malformations; arteriovenous malformations |
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| ==Overview== | | == [[Arteriovenous malformations overview|Overview]] == |
| '''Arteriovenous malformation''' or '''AVM''' is a [[congenital disorder]] of the connections between [[veins]] and [[arteries]] in the [[blood vessel|vascular system]]. The genetic transmission patterns of AVM (if any) are unknown, and AVM is not generally thought to be an inherited disorder--unless in the context of a specific hereditary [[syndrome]].
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| == Epidemiology == | | == [[Arteriovenous malformations historical perspective|Historical Perspective]] == |
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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.<ref name=NINDS/>
| | == [[Arteriovenous malformations classification|Classification]] == |
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| ==Pathophysiology== | | == [[Arteriovenous malformations pathophysiology|Pathophysiology]] == |
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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 causes|Causes]] == |
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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 differential diagnosis|Differentiating Arteriovenous malformations from other Diseases]] == |
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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 epidemiology and demographics|Epidemiology and Demographics]] == |
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| == Signs and symptoms == | | == [[Arteriovenous malformations risk factors|Risk Factors]] == |
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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.
| | == [[Arteriovenous malformations natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
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| The most general symptoms include [[headache]] and [[epilepsy]], with more specific symptoms occurring that normally depend on the location of the malformation and the individual. Other possible symptoms include:<ref name=NINDS>{{NINDS|avms|Arteriovenous Malformation Information Page}}</ref>
| | == Diagnosis == |
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| * Difficulties with movement or coordination, including [[muscle weakness]] and even [[paralysis]];
| | [[Arteriovenous malformations history and symptoms|History and Symptoms]] | [[Arteriovenous malformations physical examination|Physical Examination]] | [[Arteriovenous malformations laboratory findings|Laboratory Findings]] | [[Arteriovenous malformations CT|CT]] | [[Arteriovenous malformations MRI|MRI]] | [[Arteriovenous malformations other imaging findings|Other Imaging Findings]] | [[Arteriovenous malformations other diagnostic studies|Other Diagnostic Studies]] |
| * [[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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| ==Presentation== | | == Treatment == |
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| AVMs can occur in various parts of the body including the [[human brain|brain]] (see [[cerebral arteriovenous malformation]]), [[spleen]], [[lung]], [[kidney]], [[spinal column]], and [[liver]]. AVMs may occur in isolation or as a part of another disease (e.g. [[Von Hippel-Lindau disease]] or [[hereditary hemorrhagic telangiectasia]]).
| | [[Arteriovenous malformations medical therapy|Medical Therapy]] | [[Arteriovenous malformations surgery|Surgery]] | [[Arteriovenous malformations primary prevention|Primary Prevention]] | [[Arteriovenous malformations secondary prevention|Secondary 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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| This bleeding can be devastating, particularly in the brain. It can cause severe and often fatal [[stroke]]s. If detected before a stroke occurs, usually the arteries feeding blood into the nidus can be closed off, ensuring the safety of the patient.
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| ==Diagnosis==
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| AVMs can occur in various parts of the body
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| * [[human brain|brain]], causing a [[cerebral arteriovenous malformation]]
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| * [[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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| AVMs may occur in isolation or as a part of another disease (e.g. [[Von Hippel-Lindau disease]] or [[hereditary hemorrhagic telangiectasia]]).
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| This bleeding can be devastating, particularly in the brain. It can cause severe and often fatal [[stroke]]s. If detected before a stroke occurs, usually the arteries feeding blood into the nidus can be closed off, ensuring the safety of the patient.
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| === Pons: Arteriovenous malformation===
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| <youtube v=YcOqcu1xmFc/>
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| === Brain: Arteriovenous malformation===
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| <youtube v=mZyNihzHysk/>
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| == Treatment ==
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| Treatment can be symptomatic, or it can involve surgery or radiation therapy.<ref name=NINDS/>
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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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| <references/>
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| ==External links==
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| * [http://www.seattlechildrens.org/our_services/clinical_services/vascular_anomalies/art_malform.asp Information about arteriovenous malformations from the Children's Hospital, Seattle.]
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| * {{NINDS|avms}}
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| * [http://www.avmsupport.org.uk/ UK Support Group for AVM conditions]
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| * [http://www.behindthegray.net behindthegray.net Subarachnoid Haemorrhage support group with forums, articles, chat and general advice.]
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| * [http://www.avmfoundation.org/ AVM Foundation A non-profit organization in Virginia, USA]
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| * [http://www.impulsemonitoring.com for intraoperative monitoring of AVM surgery]
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| | ==Case Studies== |
| | [[Arteriovenous malformations case study one|Case #1]] |
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| {{Congenital malformations and deformations of circulatory system}} | | {{Congenital malformations and deformations of circulatory system}} |
| {{SIB}}
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| [[Category:Gross pathology]]
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| [[Category:Congenital disorders]]
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| [[Category:Cardiology]]
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| [[nl:arterioveneuze malformatie]] | | [[nl:arterioveneuze malformatie]] |
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