Ces radiol. 2008, 62(2):146-152

AVMs - how I treat them: alcoholReview article

Wayne F. Yakes

Vascular Malformation Center

AVMs are congenital vascular lesions typified by hypertrophied in-flow arteries and shunting through a primitive vascular nidus and into tortuous dilated out-flow veins. No intervening capillary bed is present. Symptoms are usually referable to the location of the AVM. The larger and more centrally located AVMs have a greater likelihood for cardiac overload. Other presenting symptoms include pain, progressive nerve deterioration or palsy, disfiguring mass, tissue ulceration, hemorrhage, impairment of limb function and, limiting claudication.
As catheter delivery systems and embolic agents improved, embolization has since emerged as a primary mode of therapy in the management of AVMs. In many cases, vascular malformations are in anatomically and surgically difficult or inaccessible areas; this has led to increased reliance on interventional radiology to manage these lesions.
Since ethanol completely destroys the endothelial cell, the phenomenon of recanalization and neovascular recruitment are noticeably absent. The permanence encountered with ethanol is unusual with other agents.
Because cure is possible by endovascular procedures, the role of surgery for AVMs has diminished. If cure is not possible by embolization, then either repeated transcatheter procedures and/or surgery may still have a role. With current fluoroscopic systems, vessels smaller than 1 mm can be imaged. This allows planning to spare normal structures and embolize the AVM nidus superselectively.
Vascular malformations are best treated where these patients are seen on a regular basis.

Keywords: AVMs, embolization, ethanol

Accepted: March 31, 2008; Published: June 1, 2008  Show citation