Arteriovenous Malformations

Introduction: arteriovenous malformations are infrequent pathologies, with an estimated  incidence  of  1.1  in  100,000  inhabitants.  Treatment  can  be  vascular embolization,  microsurgery,  or stereotactic  radiosurgery.  Due  to  its  low incidence, it is difficult to select a homogeneous group for long-term prospective follow-up, and based on statistically significant results to define a behavior.
Objective: to  establish  the  role  of stereotactic  radiosurgeryin  the  treatment  of cerebral AVMs.
Methods: was  performed  a  database  research  for  a  descriptive  analysis  of clinical  trials  in  patients  with  arteriovenous  malformations  treated  with stereotactic radiosurgery, without prior radiotherapy.
Results: 26 articles were selected. Most of the results come from retrospective studies.  The  estimated  obliteration  for  small  or  moderate  arteriovenous malformations  with stereotactic  radiosurgeryranges  from  61%  to  90%,  with  a morbidity of less than 5%. Response to treatment varies according to nest size, dose, and previous non-embolization. For giant arteriovenous malformations, the obliteration rate described is 35% to 58%, with a morbidity thatreaches 15%.
Conclusions: stereotactic radiosurgeryseems to be an effective and safe option when microsurgery is not considered, with satisfactory obliteration rates, without increased  risk  of  bleeding  in  the  latency  period.  In  giant  arteriovenous malformations, stereotactic radiosurgeryshows a lower complete response rate, so  multimodal  interventional  treatment  is  justifiable.  Stereotactic  radiosurgeryhas  proven  to  be  safe  and  effective,  with  a  preponderant  role  in  small,  deep arteriovenous malformations or in eloquent areas

12 years  old Hindu male child was brought  to the hospital by the parents with the complaints of focal convulsions of right side of the body with right sided facial deviation during convulsions since 2 years. It was occurring once in every 1-2 months. This was lasting initially for about 5-10 minutes then gradually the time duration increased, since last 4-5 episodes patient was having convulsion lasting for more than 3-4 hours followed by unconsciousness lasting for 5-6  hours. The Child was treated by local doctors in the form of  tab. Sodium valproate and Tab. Gardenal but with this regimen, these convulsions were not controlled.

Patients who have chronic lower gastrointestinal bleeding with negative conventional work-ups should undergo superior mesenteric arteriography to look for arteriovenous malformations. Once the diagnosis is made, treatment is immediate conventional right hemicolectomy. Six patients with arteriovenous malformations described in this report have had no recurrence of rectal bleeding in one to five years.

Objectives: It has been reported that systemic venovenous malformation (VVM) can develop in patients with interrupted inferior vena cava (IVC) and univentricular type of congenital heart disease who undergo superior vena cava to pulmonary artery connection ( ...

A male neonate with vein of Galen aneurysmal malformation developed fetal heart failure after a gestation period of 37 weeks. Labor was induced, but a cesarean section had to be performed because of fetal distress. His Apgar scores were 2/8 at birth. The boy required controlled ventilation due to generalized seizure and cyanosis. Neuroimaging revealed vein of Galen aneurysmal malformation with enormous arteriovenous shunt flows. Transarterial embolization was performed on days 4 and 6 to reduce the progressive high-output congestive heart failure. Three large feeders were occluded with interlocking detachable coils, markedly reducing the shunt flow. Although heart failure improved markedly, he died of pulmonary hemorrhage on day 12. Endovascular surgery can improve the prognosis of heart failure in the neonatal period less invasively than other treatment modalities, and may help to minimize ischemic brain damage and thus increase the possibility of normal brain maturation.

This report describes 5 patients with systemic sclerosis (SSc) who developed severe, recurrent upper gastrointestinal (GI) bleeding due to gastric antral vascular ectasia (GAVE). The clinical records, the endoscopic findings, and the histologic appearance of biopsy specimens and surgically resected gastric tissue from the patients were reviewed. All 5 patients developed severe and recurrent episodes of upper GI bleeding leading to severe anemia requiring multiple transfusions. The cutaneous involvement was diffuse in 3 patients and limited in 2. All but 1 had cutaneous telangiectasias. The diagnosis of GAVE was established by endoscopy within 3 years of the diagnosis of SSc in all cases. One patient required heater probe cautery, 2 required laser coagulation, and 2 underwent surgical resection of the gastric antrum for control of the GI bleeding. The possibility of GAVE should be considered in SSc patients who have recurrent upper GI bleeding. It is suggested that the antral vascular lesions in these patients may represent a component of the spectrum of vascular alterations of SSc.

The only treatment available to restore normal cardiac output in patients with hereditary hemorrhagic telangiectasia (HHT) and cardiac failure is liver transplant. Anti-vascular endothelial growth factor treatments such as bevacizumab may be an effective treatment.

Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations, Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical resection, and endovascular therapy. However, each method has limitations owing to recurrence, comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy, and evolving methods of sclerotherapy are promising areas of development that may mitigate limitations of current treatments and offer exciting options for patients and their physicians.

During the past decade percutaneous therapeutic vascular occlusion was performed on 152 occasions in 124 patients. The primary indication for vasoocclusive therapy was acute or recurrent bleeding. Upper gastrointestinal bleeding from arterial sources was controlled in 92 percent of patients and acute variceal bleeding in 83 percent. Renal embolization was performed for palliation of severe pain and hematuria from unresectable renal primary or secondary malignancies, to decrease blood loss and facilitate surgery in operable renal tumors, and for ablation of renal function to control chronic protein loss or severe hypertension. Our encouraging experience convinces us that transcatheter embolization is a useful, safe and effective procedure in selected patients. It seems certain that the technique of therapeutic embolization will be improved, its indications extended and its application become commonplace whenever angiographic skills and facilities exist.

Arteriovenous malformation (AVM) is an anomaly characterized by abnormal vascular communications between arteries and veins in the different organs of the body. It may be congenital or acquired. Microsurgical resection, endovascular embolization and radiosurgery (irradiation) are the three effective modes of treatment currently available. However, no objective criteria have been established for which mode(s) of treatment should be selected for individual patients with AVMs.

Arterio-venous malformations (AVMs) are congenital vascular malformations (CVMs) that result from birth defects involving the vessels of both arterial and venous origins, resulting in direct communications between the different size vessels or a meshwork of primitive reticular networks of dysplastic minute vessels which have failed to mature to become 'capillary' vessels termed "nidus". These lesions are defined by shunting of high velocity, low resistance flow from the arterial vasculature into the venous system in a variety of fistulous conditions. A systematic classification system developed by various groups of experts (Hamburg classification, ISSVA classification, Schobinger classification, angiographic classification of AVMs,) has resulted in a better understanding of the biology and natural history of these lesions and improved management of CVMs and AVMs. The Hamburg classification, based on the embryological differentiation between extratruncular and trunc...

Background and Purpose—Mutations in endoglin (ENG) and activin-like kinase (ALK1) cause hereditary hemorrhagic telangiectasias, disorders characterized by pulmonary and brain arteriovenous malformations (BAVMs). We investi- gated whether polymorphisms in these genes are also associated with sporadic BAVM. Methods—A total of 177 sporadic BAVM patients and 129 controls (all subjects white) were genotyped for 2 variants in ALK1 and 7 variants

We report a jejuno-jejunal intussusception with a polypoid arteriovenous malformation as a lead point in a 12-year-old boy, presenting with lower abdominal pain and non-bloody non-projectile vomiting. A computed tomography scan of the abdomen and pelvis showed proximal jejuno-jejunal intussusception in the right upper quadrant. Exploratory laparotomy revealed a 5.5 × 2.5 × 2 cm polypoid mass within the wall of the jejunum. Consequently, jejunal segment resection was performed with end to end jejunostomy. Our case is distinctive because it involves a rare vascular lesion at an atypical site, the jejunum, in a child with an unusual presentation of intussusception treated surgically. Many paediatric benign and surgical conditions present with similar clinical symptoms; the physician in the emergency department should try to narrow the differential diagnosis and recognize surgical emergencies to avoid any delay in intervention that could be life-threatening.

OBJECTIVE Cranioplasty is a reconstructive procedure used to restore skull anatomy and repair skull defects. Optimal skull reconstruction is a challenge for neurosurgeons, and the strategy used to achieve the best result remains a topic of debate, especially in pediatric patients for whom the continuing skull growth makes the choice of material more difficult. When the native bone flap, which is universally accepted as the preferred option in pediatric patients, is unavailable, the authors' choice of prosthetic material is a polymethylmethacrylate (PMMA) implant designed using a custom-made technique. In this paper the authors present the results of their clinical series of 12 custom-made PMMA implants in pediatric patients. METHODS A retrospective study of the patients who had undergone cranioplasty at Gaslini Children's Hospital between 2006 and 2013 was conducted. A total of 12 consecutive cranioplasties in 12 patients was reviewed, in which a patient-specific PMMA implan...

Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between the pulmonary arteries and veins. They are frequently seen as isolated anomalies, but they may also occur as multiple malformations, as in cases of hereditary hemorrhagic telangiectasia. Although PAVMs are generally asymptomatic, hemoptysis and hypoxemia may also be present. Radiologically, PAVMs often mimic solitary or multiple pulmonary nodules. The present case report is a description of the radiological appearance of PAVMs mimicking a solitary pulmonary nodule.

Both cerebral arterial aneurysm and arteriovenous malformation are cerebrovascular disease, which required immediate diagnosis and urgent treatment. Since the introduction of multislice CT scanners, CT angiography (CTA) has become a powerful tool for imaging the vascular system. The goal of this study is to compare CATHETER based angiography and CTA in the evaluation of cerebral arterial aneurysm and arteriovenous malformation AVM. A retrospective analysis of 50 patients for exploring the record of patient who underwent both multislice CT angiography (MSCTA) and CATHETER based angiography before treatment is presented during last one year in the department of Radiology, King Fahd Hospital-Jeddah, Kingdom of Saudi Arabia. The sensitivity of CTA for picking up aneurysm is 86% and the sensitivity of catheter based angiography for picking up aneurysm is 97%. The specificity of CTA for picking up aneurysm is (76%), the false positive cases are (3%) and the false negative cases are 10%. T...