What is an AVM

 

What is an AVM?

An arteriovenous malformation, or AVM for short, is a constitutional malformation of the vascular system. The vessels of the central nervous system or the facial skull are often affected. Put simply, in an AVM, arterial vessels open directly into the venous vascular system without the interposition of resistance vessels in the form of capillaries. As a result, the brain in the vicinity of the AVM loses blood for the oxygen supply on the one hand, and on the other hand, the increase in pressure in the veins, whose wall is less resistant and which often increase in caliber to cope with the blood volume, can lead to a potentially threatening cerebral hemorrhage.

How is an AVM diagnosed?

In addition to cerebral hemorrhage, the first symptom of an AVM is often a seizure disorder, with the type and intensity of the seizures being largely dependent on the location of the AVM. A major seizure does not always occur, but very mild symptoms, e.g. in the form of episodically recurring paresthesia. The causing vascular malformation itself is then shown in the imaging made to clarify the cause of the seizure disorder, usually CT or MRI. If the AVM was primarily bleeding, the spectrum of symptoms ranges from headache to neurological deficits such as paralysis and loss of consciousness. Catheter angiography should then be performed for precise assessment and therapy planning.

What therapy options are there?

There are basically three different methods of treatment available: endovascular embolization treatment, neurosurgical operation and radiation treatment. A combination of these methods is very often used.

In endovascular AVM treatment, the supplying cerebral arteries are selectively probed from the groin or the arm with a very fine microcatheter. If this succeeds, the vascular malformation can be eliminated from the circulation with a liquid embolizate (tissue adhesive) or the arterial inflow can be reduced so that, for example, a subsequent operation can be carried out with as little risk as possible. In suitable cases, however, the AVM can be completely eliminated via the vessels alone. Depending on the size of the vascular malformation and the number of supplying vessels, several treatment steps are sometimes necessary for this.

The operation with opening of the bony skull and complete removal of the AVM is usually carried out after it has been eliminated as far as possible using the endovascular route, in particular in order to minimize the surgical risk of bleeding. In the combination of the procedures, this leads to a complete elimination of the risk of bleeding in over 90 percent of the patients.

Further information for those affected

If you have been diagnosed with AVM, we offer you the opportunity to find out about the opportunities and risks of treatment in our vascular consultation in a personal conversation using the documents available.