Arteriovenous Malformation - Symptoms, Causes & Treatment

Arteriovenous malformations are irregularities in blood vessels in which arteries are directly linked to veins, bypassing the capillaries. In a normal circulatory system, arteries carry oxygen-rich blood from the heart to the tissues, while veins carry deoxygenated blood back to the heart.

In arteriovenous malformations, the absence of capillaries disrupts the normal blood flow, causing blood to rush through the tangled vessels at high pressure. This can lead to various complications, such as bleeding, seizures, or strokes.

Arteriovenous malformations can occur in different parts of the body, each with its own set of characteristics and potential complications. The main types of AVMs include:

1. Cerebral Arteriovenous Malformations occur in the brain, potentially causing headaches, seizures, or haemorrhage. They are the most common type of arteriovenous malformation and can be life-threatening if left untreated.
2. Spinal Arteriovenous Malformations develop in the spinal cord and can lead to back pain, weakness, or paralysis. These are rare but can cause significant neurological deficits.
3. Pulmonary Arteriovenous Malformations form in the lungs, causing shortness of breath, cyanosis, or paradoxical embolism. This category is often associated with hereditary hemorrhagic telangiectasia (HHT).
4. Peripheral Arteriovenous Malformations occur in the arms, legs, or other parts of the body, potentially causing pain, swelling, or skin discolouration. These can be disfiguring and may require surgical intervention.

Grades of Arteriovenous Malformations

The Spetzler-Martin grading system is used for cerebral AV malformation classification based on a variety of factors. Higher grades indicate more complex AVMs.

Patients with arteriovenous malformations may develop severe symptoms depending on their location and size. Common AVM symptoms include:

• Headaches: Sudden, severe headaches may occur, especially if the disease is located in the brain. These headaches may also be associated with symptoms such as nausea, vomiting, or light sensitivity.
• Pain: AV malformations can cause localised pain, especially if they compress nearby nerves or tissues. The pain may worsen with activity or changes in position.
• Bleeding: Arteriovenous malformations can rupture, causing bleeding in the brain (hemorrhagic stroke), spinal cord, or other affected areas. Symptoms of bleeding may include sudden, severe headache, neck stiffness, or loss of consciousness.
  
• Bruit: In some cases, a whooshing or humming sound (bruit) may be heard over the AVM site due to the rapid blood flow through the abnormal vessels.
• Skin Discolouration: Peripheral arteriovenous malformations may cause the overlying skin to appear red, purple, or blue due to the abnormal blood vessels.
• Seizures: Arteriovenous malformations in the brain can cause abnormal electrical activity. Seizures may manifest as loss of consciousness, muscle spasms, or unusual sensations
• Neurological Deficits: The location of the AVM can lead to weakness, numbness, or challenges with speech or coordination. These symptoms can be temporary or permanent.

The exact cause of arteriovenous malformations is not completely understood, but it occurs during foetal development or shortly after birth. These malformations result from errors in the formation of blood vessels, leading to abnormal connections between arteries and veins.

Risk Factors for Arteriovenous Malformations

Several risk factors have been identified that may increase the likelihood of developing this condition. These include:

1. Trauma: In rare cases, arteriovenous malformations may develop after a traumatic injury to the affected area. This is thought to be due to the disruption of normal blood vessel structure and function.

2. Age: Arteriovenous Fistula can occur at any age but are often diagnosed in young adults or middle-aged individuals.

3. Genetic History: Having a family member with an AVM or a related genetic disorder, such as HHT, may increase the risk. 

Currently, there are no known ways to prevent the development of AV malformations, which are thought to occur during foetal development or shortly after birth. Since the exact cause is not fully understood, it is difficult to identify specific preventive measures.

However, individuals with a family history of AVMs or related genetic disorders, such as hereditary hemorrhagic telangiectasia (HHT), may benefit from genetic counselling. The process helps families understand their risk of developing AVMs and make informed decisions.

Additionally, early detection and prompt arteriovenous malformation treatment of AVMs can help prevent complications and improve outcomes.

Diagnosing AV malformations involves a combination of clinical evaluation and imaging studies to assess AVM symptoms and medical history. The diagnostic process usually involves these steps:

1. Medical History and Physical Examination: Healthcare providers will check for symptoms, family history, and perform a thorough analysis. They may listen for a bruit over the affected area or check for neurological deficits.
2. Imaging Studies: Various techniques can be used to visualise the AVM and assess its size, location, and blood flow characteristics. These may include computed tomography (CT) scans, magnetic resonance imaging (MRI), or angiography.
3. Functional Tests: These are performed to assess the impact of the AVM on brain function or blood flow. They may include electroencephalography (EEG) or transcranial Doppler ultrasound.
4. Biopsy: The test is conducted to confirm the diagnosis of an AVM or rule out other conditions. This procedure involves extracting tissue from the affected area for analysis under a microscope.

How to prepare for the doctor's consultation?

By gathering relevant information and organising questions in advance, a patient can look forward to an informative visit. To prepare, individuals should:

1. Document the frequency and severity of AVM symptoms, such as headaches, seizures, or neurological deficits.
2. Make note of any prior surgeries, treatments, or medical conditions that may be relevant to the Arteriovenous Fistula diagnosis.
3. Bring any recent imaging studies, such as CT scans and MRIs, to the appointment.
4. Discuss family history of arteriovenous malformations or related genetic disorders with the neurosurgeon/pulmonologist.
5. Provide a complete list of current medications, supplements, and remedies being used. Certain medications may interact with AVM treatment options.

Questions to Ask the Neurosurgeon/Pulmonologist

Asking the right questions can help patients understand their condition better. While making a list of questions for the doctor, they should consider adding the following:

1. What is the size and location of the AVM?
2. What are the possible risks and complications related to AVMs?
3. What arteriovenous malformation treatment options are available, and which is most suitable for the individual case?
4. What are the expected outcomes and recovery time for each treatment option?
5. Are there any lifestyle modifications or precautions that should be taken to manage the AVM?

The arteriovenous malformations treatment depends on factors like location, size, and severity of the condition. Treatment options may include:

Ayurvedic Treatments

Ayurveda for AVMs focuses on natural remedies and holistic management to minimise symptoms and promote healing.

• Panchakarma: A series of detoxification procedures that help balance the doshas and improve circulation.
• Herbal Formulations: Ayurvedic herbs such as Brahmi, Shankhapushpi, and Jatamansi may be used to support brain health and reduce inflammation.
• Lifestyle Modifications: To support overall health, Ayurvedic practitioners may recommend changes in diet, sleep patterns, and stress management.

Homoeopathic Treatments

Homoeopathy offers personalised remedies to manage symptoms and promote natural healing without invasive procedures. Options include:

• Arnica: Used for treating bruising, swelling, and pain associated with AVMs.
• Belladonna: Helpful in managing headaches, seizures, and neurological symptoms related to cerebral AVMs.
• Phosphorus: May be used to address bleeding tendencies and improve blood clotting.

Non-Surgical Treatment

It is effective for managing mild to moderate cases. The treatment includes:

• Medications: Anti-epileptic drugs can help control seizures, while pain relievers may be used for headaches or localised pain.

Surgical Treatments

AVM surgery is considered for severe cases or when other treatments do not offer relief to the patient. Available methods include:

1. Surgical Resection: Open surgery to remove the AVM, typically used for large or symptomatic AVMs that are accessible.
2. Endovascular Embolisation: A procedure with minimal invasion that involves injecting a substance to block blood vessels feeding the AVM.
3. Sclerotherapy: It is recommended as a non-invasive technique to shrink venous malformation by injecting specialised chemicals in them.
4. Stereotactic Radiosurgery: A technique that employs targeted radiation beams to target and destroy abnormal blood vessels.

I recently treated a young patient with a complex arteriovenous malformation that had been causing debilitating headaches and seizures. The tangled web of abnormal blood vessels was risky to navigate, but after a carefully planned surgery, we were able to successfully remove the AVM. 

Seeing the relief on his and his family's faces as he began to live pain-free was truly gratifying. Moments like these, where life is reclaimed, make this work incredibly fulfilling.

- Dr Himanshu Champaneri

Neuro Surgeon

Arteriovenous Malformation Treatment Cost

The overall cost of AVM treatment in India depends on factors such as the choice of hospital, post-operative care, and follow-up visits.

Postponing arteriovenous malformation treatment can lead to severe complications and potentially life-threatening consequences. The following are some risks associated:

1. Frequent Seizures: Arteriovenous malformations in the brain can cause abnormal electrical activity, resulting in recurrent seizures.
2. Progressive Neurological Deficits: As AVM causes pressure on surrounding tissues, it can lead to worsening neurological symptoms, such as weakness, numbness, or difficulty with speech.
3. Haemorrhage: Untreated arteriovenous malformations have a higher risk of rupturing and causing bleeding in the brain or spinal cord.
4. Aneurysm Formation: The disease can cause abnormal dilation of blood vessels, leading to the development of aneurysms. Aneurysms are weakened areas in the blood vessel wall that can rupture.
5. Increased Complexity of Treatment: AVM causes more damage to surrounding tissues as it grows. Delaying treatment can increase the complexity of treatment.

When to consult a neurosurgeon/pulmonologist?

Recognising when to seek medical attention for suspected arteriovenous malformations is crucial for timely diagnosis and treatment. Consult a doctor if experiencing any of the following symptoms:

1. Intense headache, especially if accompanied by nausea
2. Seizures or convulsions
3. Neurological deficits, such as numbness or difficulty with speech
4. Bruit
5. Skin discolouration, warmth, or swelling over the affected area

While there is no specific diet to treat arteriovenous malformations, maintaining a healthy diet can support overall brain health. Consider the following recommendations:

• Eat a variety of fruits and vegetables, such as berries, leafy greens, and cruciferous vegetables. These will support brain function and vascular health.
• Incorporate whole grains such as quinoa, whole-wheat bread, and brown rice. These are essential for fibre, B vitamins, and nutrients that benefit cardiovascular health.
  
• Incorporate lean proteins, such as fish, poultry, legumes, and nuts, into the diet. These foods are beneficial for tissue repair and maintaining healthy blood vessels.
• Choose healthy fats which help reduce inflammation and support brain health. Omega-3 fatty acids are particularly beneficial for vascular health.
• Reduce intake of processed foods to avoid inflammation and protect vascular health. Opt for healthier alternatives in diet to support overall well-being.

When managing an arteriovenous malformation (AVM), timely intervention is crucial to prevent serious complications. Regular consultations with healthcare providers can ensure effective management and optimal outcomes.

For expert care and comprehensive AVM treatment, rely on HexaHealth. Our skilled team offers precise and compassionate care tailored to individual needs. Reach out to us today for a seamless and supportive experience!