Recent Advances In Management Of Peripheral Arteriovenous Malformations

Abstract

Arteriovenous malformations (AVMs) are high flow lesions that consist of feeding arteries, draining veins, and multiple dysplastic vessels connecting these arteries and veins forming the nidus of the lesion. Clinically, AVMs are associated with overgrowth, hyperemia, pulsatility, and pain. In advanced stages, skin and tissue loss, bleeding, and infrequently, high-output heart failure may occur. The diagnoses of AVMs were made based on the clinical examination and proper investigations. Ultrasound studies quickly confirm the high-flow nature of the lesion. Computed tomography (CT), magnetic resonance imaging (MRI) and selective angiography could be performed to obtain the detailed anatomical and hemodynamic information of AVMs. CT and MRI are also good imaging modalities for the evaluation of residual lesions or recurrence after treatment. The management of arteriovenous malformations represents some of the greatest challenges facing vascular surgeons and other specialists. Occlusion of the feeding arteries alone by ligation or embolization produces a temporary decrease in flow through the malformation, but if the nidus is still present, it is reperfused through collateral vessels quickly. Current management of AVMs based on the new concept of multidisciplinary approach, can minimize the morbidity and reduce recurrence. There has been further expansion of the limited role of embolo/sclerotherapy as an adjunctive therapy for conventional surgical resection. Multidirectional use of transarterial, transvenous, or percutaneous combinations has been helpful. There must be a positive balance between subsequent morbidity and the treatment gains from an aggressive plan. The importance of careful assessment of the treatment strategy before the therapy is instituted, based on the ratio of the benefit versus potential risk, cannot be overemphasized. Amputation should not be excluded as one of the practical options, especially when the AVM is in an extremity with total loss of function.