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AVM Embolization

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    Arteriovenous Malformations

    Arteriovenous malformation (AVM) is an abnormal communication between an artery and a vein. Arteries delivers rich fresh blood to the tissues and the veins drain the tissues of used old blood. This happens through an exchange medium called the capillary bed. In an AVM, this exchange isn’t formed properly and as such proper exchange of the new and old blood does not occur. The incidence of an AVM is 1-2 cases per 100,000.1,2

    Normal communication of blood vessels is crucial for maintaining healthy functioning tissues.3 The abnormal connection disrupts oxygenation of the tissues, causing tissue damage.

    Arteriovenous vascular malformations can be divided into two types:

    • Hemangiomas – benign (non-cancerous) vascular tumors most commonly found in children. They are often small or undetectable at birth and appear within weeks to months after birth. Fortunately, they regress spontaneously by the 2 to 6 years of age.
    • Vascular malformation – as described previously, the appear at birth and do not regress.

    Arteriovenous Malformations Diagnosis

    Various modalities can be used to diagnose AVMs including:

    • Physical Examination
    • Ultrasound – simple quick test to see if the lesion has vascular flow and distinguish from other types of malformations
    • Angiography – gold standard test to evaluate and treat an AVM by injecting a contrast dye in the blood vessel
    • CT scan –most helpful in determining the anatomy of an AVM
    • MRI – can detect the extent and size of an AVM

    Causes of Arteriovenous Malformations

    The exact cause of arteriovenous malformations is not known. Most cases are congenital however they can also occur after birth.6 AVMs can occur after trauma if there is damage to the blood vessels. Certain genetic alteration (mutations) might be the underlying reason for development; however, most types of AVM’s aren’t inherited. Some associated conditions include hemorrhagic telangiectasia  (HHT) aka Osler-Weber-Rendu syndrome.

    Should Arteriovenous Malformation be Treated?

    If untreated AVMs can lead to various complications including:

    • Brain hemorrhage or bleeding
    • Seizures
    • Paralysis
    • Hypertension
    • Ulceration
    • Deep veinous thrombosis (DVT)
    • Ischemia or death of various tissues due to loss of blood supply
    • Deformity of the soft tissue and bones

    Treatment Options for Arteriovenous Malformations

    Due to the potential complications definitive treatment is advised. The main goal of the treatment is to close the AVM.

    Non-surgical embolization is the gold standard and least invasive treatment option. Our Vascular & Interventional Radiologist (IR) performs an angiogram using tiny wires and catheters to visualize the vascular anatomy of the affected area. Once the AVM is visualized, our specialist will guide a tiny catheter into the AVM. Small coil, plugs or liquid embolics will then be advanced through the catheter into the AVM cutting off the blood flow and shutting down the AVM.

    Surgery is a much more invasive treatment option and is reserved for patients who are not amenable to embolization.

    Stereotactic radiosurgery is used for selected patients with small and deep AVMs not amenable to embolization. The procedure uses highly focused and intense radiation beams to damage and close the AVM.2,7

    Treatment Outcomes

    The treatment outcomes for AVM varies for everyone and is dependent on the size, location, and type of AVM. Most patients have successful treatment outcomes with non-surgical AVM embolization. Surgical resection or ligation has seen poor results and may lead to complications like enlarging of the AVM. According to recent studies, patients undergoing AMV embolization achieved 70-100% successful closure of the AVM. Vascular embolization is a highly effective and safe treatment for AVMs.2,5,7–9

    Reference List:

    1. Abecassis IJ, Xu DS, Batjer HH, Bendok BR. Natural history of brain arteriovenous malformations: a systematic review. Neurosurgical focus. 2014;37(3). doi:10.3171/2014.6.FOCUS14250
    2. Zyck S, Sampath R. Arteriovenous Malformations. StatPearls. Published online August 19, 2021. Accessed March 14, 2022. https://www.ncbi.nlm.nih.gov/books/NBK531479/
    3. Arteriovenous Malformations and Other Vascular Lesions of the Central Nervous System Fact Sheet | National Institute of Neurological Disorders and Stroke. Accessed March 15, 2022. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Arteriovenous-Malformation-Fact-Sheet#top
    4. Madani H, Farrant J, Chhaya N, et al. Peripheral limb vascular malformations: an update of appropriate imaging and treatment options of a challenging condition. The British Journal of Radiology. 2015;88(1047). doi:10.1259/BJR.20140406
    5. Embolotherapy of Peripheral Arteriovenous Malformations – Endovascular Today. Accessed March 27, 2022. https://evtoday.com/articles/2005-nov/EVT1105_F7_Lumsden.html
    6. Chen W, Choi EJ, McDougall CM, Su H. Brain arteriovenous malformation modeling, pathogenesis, and novel therapeutic targets. Translational stroke research. 2014;5(3):316-329. doi:10.1007/S12975-014-0343-0
    7. Arteriovenous malformation – Symptoms and causes – Mayo Clinic. Accessed March 14, 2022. https://www.mayoclinic.org/diseases-conditions/arteriovenous-malformation/symptoms-causes/syc-20350544
    8. Arteriovenous Malformation (AVM): Causes, Symptoms & Treatments. Accessed March 14, 2022. https://my.clevelandclinic.org/health/diseases/16755-arteriovenous-malformation-avm
    9. Bouwman FCM, Botden SMBI, Verhoeven BH, et al. Treatment Outcomes of Embolization for Peripheral Arteriovenous Malformations. Journal of Vascular and Interventional Radiology. 2020;31(11):1801-1809. doi:10.1016/J.JVIR.2019.12.811

    The above information explains what is involved and the possible risks. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion.

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