Vascular Birthmarks Conditions: Arteriovenous Malformation (AVM)

What is Arteriovenous Malformation?

There may be instances when more than one type of tissue is present in a vascular malformation. For example, capillary malformations may be present alongside venous and/or lymphatic malformations. Arteriovenous malformations are another example where abnormal arteries and veins develop together.

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Forearm arteriovenous malformation, or AVM.
Forearm arteriovenous malformation, or AVM.

In fact, there are certain syndromes that can be associated with combined vascular malformations, such as Klippel Trenaunay and Parkes Weber syndromes.

Combined malformations are typically much more complex than their isolated counterparts. Multiple treatment options are available for the various symptoms that may be present–symptoms such as pain, ulceration, bleeding, and infection. Diagnosis and management of these malformations is best handled by a multidisciplinary team.

AVMs are different from other types of vascular malformations in that they are significantly more aggressive. Trauma or surgery of the involved area can trigger growth of the mass and worsening of symptoms. They can “steal” blood flow from areas further away causing ulcerations and decreased blood flow to fingers and toes. In the worst case, they can cause heart failure secondary to overexertion of the heart to provide blood flow to the area. Treatment can include embolization, sclerotherapy, or surgery. Compression garments can also be helpful.

Dr. Panossian has been treating patients with AVMs for over a decade. Treatment is usually reserved for patients that have become symptomatic, as described above. Surgery is still considered to be the only curative intervention, however, a combined approach is often employed. Surgery may or may not be preceded with embolization of large feeding arteries. Embolization alone may be helpful in alleviating symptoms temporarily and under rare circumstances, can stop expansion of an AVM. New approaches are being researched. Although benign, AVMs are considered one of the most difficult vascular malformations to treat.

MR angiogram of hand with AVM.
MR angiogram of hand with AVM.

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Last modified by Dr. Andre Panossian

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