Arteriovenous malformations (AVM) are abnormal blood vessels that connect arteries and veins. Arterial vein malformations are generally congenital, meaning they are present at birth.
Basically, the circulatory system has three types of blood vessels, namely arteries, veins, and capillaries. Arteries act as a supplier of oxygen-rich blood from the heart to the body's cells, while veins function to return blood full of carbon dioxide from the body's cells to the heart.
Arteries and veins are connected by tiny, thin blood vessels called capillaries. When blood from the arteries passes through the capillaries to the veins, the blood flow will slow down so that the process of exchange of oxygen (from blood to tissues) and carbon dioxide (from tissues to blood) runs optimally.
When an arteriovenous malformation occurs, the arteries and veins are connected directly without going through the capillaries. This condition then causes disturbances in the circulatory system in the body and has the potential to cause death.
Causes of Arterial Venous Malformations
In arteriovenous malformations, the blood vessels that connect arteries and veins are large and thick, unlike capillaries. This disorder can occur in various parts of the body, but is most common in the brain, neck, and spine.
Not yet known with certainty the process behind the formation of the AVM. However, there are allegations that this condition occurs due to genetic abnormalities in the fetus due to heredity. In addition, it is also suspected that malformations of blood vessels can occur after birth (to adulthood) due to injury to the central nervous system.
Arterial venous malformations are more at risk in people who have the following factors:
- Male gender
- Have a family history of arteriovenous malformations
- Have a family history of genetic disorders, such as Cobb syndrome, hereditary hemorrhagic telangiectasia, and Sturge-Weber syndrome
Symptoms of Arterial Venous Malformation
Blood flow from arteries to veins in arteriovenous malformations is different from blood flow in capillaries. In an AVM, the blood flow can become too fast, making the exchange of oxygen and carbon dioxide ineffective.
Even so, arteriovenous malformations generally do not cause any symptoms. This condition only causes symptoms when the AVM increases in size, usually as a result of puberty, pregnancy, or injury.
In some cases, an AVM can cause the surrounding tissue to not get an adequate blood supply. Large AVMs can also compress surrounding tissue and cause disruption.
Specifically, the symptoms of arteriovenous malformations can be divided based on the location or age of the sufferer. Here is the explanation:
Arterial venous malformations in the brain
Early symptoms that can occur are:
- Learning difficulties and behavioral disorders in children and adolescents
- Headache or migraine
- Numbness and tingling in certain body parts
- Seizures
In certain cases, arteriovenous malformations can be damaged or ruptured. These conditions can lead to more serious symptoms, including:
- Nausea and vomiting
- Severe headache
- Weakness, numbness, or paralysis
- Loss of sight
- Difficult to speak
- Difficult to plan
- Confused or difficult to interact with others
- Difficult to maintain body balance
- Loss of consciousness
- Memory loss
- hallucination
Marteriovenous malformations in the spine
Common symptoms are:
- Immovable arms and legs
- muscle weakness
- Body balance disorder
Arterial venous malformations in organs, chest, or abdomen
Symptoms of an AVM in this location may be easier to feel and more bothersome. Symptoms that may appear include:
- Stomach pain
- Back pain
- Chest pain
- The sound of blood flowing from the malformed blood vessels
In addition, a type of arteriovenous malformation called Galen's venous malformation can cause special symptoms in newborns or under 2 years of age. These symptoms can include:
- hydrocephalus
- Swelling of blood vessels in the scalp
- Seizures
- Failed to grow
- Congenital heart failure
Although it can appear at any time, symptoms of arteriovenous malformation are more common at the age of 10-40 years. This condition is usually stable and does not cause symptoms if it has reached the age of 50 years.
Arterial Venous Malformation Stage
In general, the severity of arteriovenous malformations can be classified as follows:
- Stage 1: AVM has no symptoms or has only mild symptoms, such as a warm area of skin on the affected area or redness.
- Stage 2: The AVM increases in size and produces a pulse that can be felt or heard.
- Stage 3: The AVM causes pain, bleeding, or sores.
- Stage 4: AVM causes heart failure due to the large amount of ineffective blood flow in the body.
When to go to the doctor
Seek immediate medical attention if you experience any of the symptoms mentioned above, especially if you have risk factors for arteriovenous malformations. Brain bleeding due to arteriovenous malformations can be life-threatening, so it is necessary to get medical treatment as early as possible.
If your family has a history of arteriovenous malformations, talk to your doctor about your and your child's risk of developing this condition. This needs to be done immediately if there are early symptoms of AVM such as migraines or headaches, difficulty concentrating or learning difficulties, or seizures for no apparent reason.
Diagnosis of Arterial Venous Malformation
The diagnosis of arteriovenous malformations usually begins by asking the patient's symptoms and medical history. After that, the doctor will perform a complete physical examination. If possible, the doctor will listen to the sound of blood flow in the area that is experiencing complaints.
To confirm the diagnosis, the examination is continued by conducting a series of tests. Tests that can be used to diagnose arteriovenous malformations include:
- Angiography, to see in detail the shape of the veins and arteries
- CT scan, to produce images of organs, such as the head, brain, and spine, and to help detect bleeding
- MRI, to produce images of the condition of organ tissues, including blood vessels, with more detail
- MRA, to determine the pattern, speed, and range of blood flow in malformed blood vessels
Arterial Venous Malformation Treatment
Treatment of arteriovenous malformations aims to relieve the symptoms experienced, improve the patient's quality of life, and prevent bleeding. The treatment method used will be adjusted to the location and size of the arteriovenous malformation, the patient's age, and the patient's general health.
There are several treatment methods that can be done, namely:
Drugs
Doctors can give drugs to relieve symptoms that appear. For example, analgesic-antipyretic drugs to relieve headaches, and anticonvulsant drugs (such as Carbamezapine or lorazepam) to treat seizures.
Operation
Surgery is generally performed if the arteriovenous malformation is at risk for rupture. The purpose of this procedure is to repair or remove damaged blood vessels.
Some of the common surgical methods used by doctors to treat arteriovenous malformations are:
- EmbolizationendovascularThe doctor will insert a catheter into the artery, then insert a special substance that functions to block and reduce blood flow to the malformed arteries and veins.
- Stereotacticradiosurgery
Stereotactic radiosurgery It is commonly used to treat small to medium-sized arteriovenous malformations.
- OperationraptureAVM
If the malformation is in a deep part of the brain, the patient is at high risk for complications. Therefore, the doctor will use another method.
Routine check up
After undergoing treatment with the methods above, the patient still needs to have regular check-ups with the doctor. The examination includes a scan to make sure the arteriovenous malformation has healed completely and has not recurred.
Routine examinations will also be recommended if the arteriovenous malformation is in a part of the body that is difficult to treat, or is asymptomatic and only requires the supervision of a doctor.
Complications of Arterial Venous Malformation
Complications that can occur in patients with arteriovenous malformations can vary. However, the most common complications from arteriovenous malformations include:
- Hemorrhagic stroke or ischemic stroke
- Seizures
- Numbness in certain body parts
- Difficulty speaking or moving
- Developmental delays in children
- Hydrocephalus in babies
- Permanent brain damage
- Decreased quality of life
- Death due to bleeding
Prevention of Arterial Venous Malformations
As described above, the exact cause of arteriovenous malformations is not known. Therefore, it is not yet known how to prevent this condition from occurring. The best thing that can be done is to treat the symptoms experienced early to prevent complications, for example by:
- Taking medication prescribed by a doctor
- Control high blood pressure (if any)
- Do not take drugs or herbal products that can thin the blood without a doctor's confirmation
- Undergo regular check-ups with the doctor
