Arteriovenous Malformations

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Information about Arteriovenous Malformations
Health & Medicine
kfu

Published on February 23, 2009

Author: Dr_Shammasi

Source: slideshare.net

Dr. Ahmed Mirza Al-Shammasi 2031040009 Surgical Intern - KFU – Saudi Arabia Arteriovenous Malformations

Outlines Definition Classification Epidemiology Pathophysiology Clinical Presentation Diagnosis Management

Definition

Classification

Epidemiology

Pathophysiology

Clinical Presentation

Diagnosis

Management

Arteriovenous Malformations Congenital Vascular anomaly in which there is abnormal connection between the arterial and venous systems. Malformed vessel that results from developmental arrest during embryogenesis.

Congenital Vascular anomaly in which there is abnormal connection between the arterial and venous systems.

Malformed vessel that results from developmental arrest during embryogenesis.

Vascular Anomalies One of the most confusing and misunderstood conditions. History of inconsistent terminology: Strawberry Nevus Cherry Hemangioma Port-wine stain Confusion between Vascular malformations and Vascular tumors of childhood.

One of the most confusing and misunderstood conditions.

History of inconsistent terminology:

Strawberry Nevus

Cherry Hemangioma

Port-wine stain

Confusion between Vascular malformations and Vascular tumors of childhood.

International Society for Vascular Anomalies in 1996 Vascular Anomalies Vascular Tumors of Childhood Vascular Malformations Capillary Hemangioma Cavernous Hemangioma Mixed Hemangioma Venous Arteriovenous Arterial Combined, Mixed Lymphatic

 

 

Epidemiology Records from the Heim Pal Hospital for Children in Budapest indicated an incidence of 1.2%. Both sexes are affected equally. No racial predilection has been identified. Venous Malformation is the most common (50%) Followed by AVM, then Combined, lastly Arterial. AVM is more common in the intracranial vasculature, most dangerous type.

Records from the Heim Pal Hospital for Children in Budapest indicated an incidence of 1.2%.

Both sexes are affected equally.

No racial predilection has been identified.

Venous Malformation is the most common (50%)

Followed by AVM, then Combined, lastly Arterial.

AVM is more common in the intracranial vasculature, most dangerous type.

Pathophysiology Arrest in the development of the primitive vascular system. Depending on the stage of arrest, divided into: Truncular and Extratruncular. Arteries have deficient Mascularis layers, veins are dilated due to high flow. The exact underlying eitiology is unknown

Arrest in the development of the primitive vascular system.

Depending on the stage of arrest, divided into: Truncular and Extratruncular.

Arteries have deficient Mascularis layers, veins are dilated due to high flow.

The exact underlying eitiology is unknown

Clinical Presentation Present as: Mass lesion Birthmarks Atypical varicosities Limb enlargement Most are evident at birth, except AVM which present at early childhood or adolescence.

Present as:

Mass lesion

Birthmarks

Atypical varicosities

Limb enlargement

Most are evident at birth, except AVM which present at early childhood or adolescence.

Venous Malformations Most common type, 50%. Pure venous or mixed. Diffused, soft, non-pulsatile, compressible mass, bluish hue. Rapid refilling after release of pressure. Tend to enlarge over time, darkening and superficial thickening Complications: Thrombophlebitis, Infection.

Most common type, 50%.

Pure venous or mixed.

Diffused, soft, non-pulsatile, compressible mass, bluish hue.

Rapid refilling after release of pressure.

Tend to enlarge over time, darkening and superficial thickening

Complications: Thrombophlebitis, Infection.

 

Arteriovenous Malformations Cluster of AVFs that remained from early embryonic development. Account for 1/3 of cases of VA. Potentially the most serious type. More common intracranially. Present commonly in later childhood, adolescence or early adulthood. Complications: Steal syndrome (Ischemia, Pain, Ulceration), Bleeding.

Cluster of AVFs that remained from early embryonic development.

Account for 1/3 of cases of VA.

Potentially the most serious type.

More common intracranially.

Present commonly in later childhood, adolescence or early adulthood.

Complications: Steal syndrome (Ischemia, Pain, Ulceration), Bleeding.

Staging of AVMs Stage Manifestation Stag I Quiescence Cutaneous blush or warmth Stage II Expansion Bruit, thrill or other signs of expansion Stage III Destruction Pain, bleeding, ulceration or infection Stage IV Decompensation Cardiac Failure

 

Arterial Malformations Least common type, 1-2% of total. Under-development of an arterial segment. Blood flows normally through an undeveloped side channel or collateral. Enlarging bypassing segment is vulnerable to: Compression/Injury Aneurysmal dilatation Clot formation/obstruction Ex. Persistent Sciatic Artery

Least common type, 1-2% of total.

Under-development of an arterial segment.

Blood flows normally through an undeveloped side channel or collateral.

Enlarging bypassing segment is vulnerable to:

Compression/Injury

Aneurysmal dilatation

Clot formation/obstruction

Ex. Persistent Sciatic Artery

Diagnosis Essentially by Imaging studies: US (initial evaluation) CT scan, CT Angiography MRI, MRA (leading imaging modality) Conventional Angiography Diagnosis Determine the extent of the lesion Search for associated abnormalities

Essentially by Imaging studies:

US (initial evaluation)

CT scan, CT Angiography

MRI, MRA (leading imaging modality)

Conventional Angiography

Diagnosis

Determine the extent of the lesion

Search for associated abnormalities

 

 

 

Management Venous Malformations: Compressive stockings ± Aspirin Sclerotherapy, LASER surgery, Resection Arteriovenous Malforamtions: Conservative treatment in absence of symptoms Super-selective embolization followed by sclerotherapy Selective embolization followed by surgical resection

Venous Malformations:

Compressive stockings ± Aspirin

Sclerotherapy, LASER surgery, Resection

Arteriovenous Malforamtions:

Conservative treatment in absence of symptoms

Super-selective embolization followed by sclerotherapy

Selective embolization followed by surgical resection

Management Lymphatic Malformations Compressive stockings are the mainstay of ttt. Soft tissue debulking. LASER Surgery, Surgical resection

Lymphatic Malformations

Compressive stockings are the mainstay of ttt.

Soft tissue debulking.

LASER Surgery, Surgical resection

References Rutherford Vascular Surgery, 6 th edition. Terminology and classification of congenital vascular malformations. Phlebology 2007; 22: 249–252 Evaluation and Treatment of Musculoskeletal Vascular Anomalies in Children: An Update and Summary for Orthopaedic Surgeons. UPOJ 2001; 14: 15-24 Arteriovenous Malformations. H Christian Schumacher, MD Internet: www.emedicine.com www.vdf.org

Rutherford Vascular Surgery, 6 th edition.

Terminology and classification of congenital vascular malformations. Phlebology 2007; 22: 249–252

Evaluation and Treatment of Musculoskeletal Vascular Anomalies in Children: An Update and Summary for Orthopaedic Surgeons. UPOJ 2001; 14: 15-24

Arteriovenous Malformations. H Christian Schumacher, MD

Internet:

www.emedicine.com

www.vdf.org

Thank You

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