Congenital Vascular Malformations with Arteriovenous Fistulae: Diagnosis and Treatment

Abstract

Background: Arteriovenous malformations (AVMs) are congenital high flow vascular malformations (VMFs) composed of anomalous capillary beds shunting blood from the arterial system to the venous system. They are infiltrative causing destruction of the local tissue and often severe bleeding. Objectives: The aim of this study was to review the clinical results of surgical treatment for AVMs, with preoperative scleratherpy. Patients and methods: 24 patients with AVMs and AVFs were treated in a period from October 2012 to March 2015. All patients were subjected to history taking, clinical examination, laboratory investigations and imaging studies which included: colored Duplex ultrasound, CTA, arteriography and direct haemangiography. All patients were treated by surgical excision after preoperative injections of sclerotherapy. Results: Age incidence of the patients ranged between 1-35 years, 70.8% of them were below the age of 5 years and 80% of the patients were females. The common site for AVMs was the head and neck in 66.67%. Symptoms and sings included: cosmetic 83.33%, thrill and pulsating mass 75%, sensation of heat 66.67%, while pain, tissue necrosis, bleeding, port-win stain and cardiomegaly were the least symptoms and sings. All patients were treated by surgical excision after preoperative sclerotherapy. Conclusions: Surgical treatment of AVM is a challenging issue for vascular surgeons. To minimize the complications related with surgery, a multidisciplinary team approach should be considered.