Case Of Arteriovenous Malformation Research Articles

Vascular Organization: Lessons from Development and Disease.

Organ formation requires tight coordination with vascular growth. Intricate networks of blood vessels course through all organs and tissues and are composed of both endothelial cells (ECs) and associated mural cells. Despite decades of research into the biology of blood vessel formation and homeostasis, little is known about how the vasculature ensures its properly coordinated growth and intimate development with the cells of different organs. Even more mystifying is how a highly dynamic endothelium quiesces to differentiate into mature vessels, and how disruption of this mature quiescence results in pathological conditions. Interestingly, both intra- and interorgan vascular architecture hold critical importance to the maintenance of blood vessels, as the rate of flow and supply of supportive angiogenic factors can be altered with deleterious effects. In this article, we review the basic mechanisms of blood vessel formation and maintenance with an emphasis on organ-specific vascular development, and we examine the case of transient pulmonary arteriovenous malformations as a case study of vascular homeostatic mechanisms.

Nasopharyngeal arteriovenous malformation. Rare clinical observation

Arteriovenous malformation (AVM) of the head and neck is a rare disease developing during embryo- and vasculogenesis due to RASA1 mutation which is inherited in accordance with autosomal dominant pattern and is associated with CMC1 locus on the long arm of the 5th chromosome 5q13.3. Statistically, AVMs are rarer than other congenital vascular abnormalities such as lymphatic or venous malformations. While AVMs are non-malignant neoplasms, among all vascular abnormalities they are the most aggressive, destructive and complex in their structure. In international literature, a small number of articles describing cases of this pathology exists (for example, I.T. Jackson et al. analyzed 16 cases of this pathology, M.T. Chen et al. reported on 14 cases, M.P. Kohaut et al. analyzed 81 cases of extracranial AVMs).In Russin literature, the number of articles describing clinical cases of AVM is in the single digits, and this topic remains quite relevant. The article presents a rare clinical observ

A Case of Arteriovenous Malformation of the Left Leg Aggravated by Ligation and Attempted to Preserve the Affected Limb

A Case of Arteriovenous Malformation of the Left Leg Aggravated by Ligation and Attempted to Preserve the Affected Limb

Uterine vascular abnormalities linked to pregnancy complications: color and power Doppler-assisted transvaginal ultrasound evaluation.

Abnormal uterine vascular pattern can be observed during transvaginal ultrasound examination used for investigating post-abortion bleeding and secondary postpartum hemorrhage. The purpose of this series of cases was to evaluate almost all the rare causes of uterine vascular abnormalities linked to pregnancy complications, and determine how to arrive at the diagnosis to optimize patient management, which is crucial for preventing life-threatening massive vaginal bleeding. Retrospective observational case series study including 20 women with postpartum or post-abortion vaginal bleeding who were found to have an abnormal uterine vascular pattern during a transvaginal color duplex assessment. The study yielded the following findings: 10 cases of enhanced myometrial vascularity, two cases of pseudoaneurysm in the uterine artery, one case of myometrial venous varix, one case of large uterine venous pseudoaneurysm, one case of uterine arteriovenous malformation, one case of retained placental polyp, one case of invasive vesicular mole, and three cases of subinvolution of the placental implantation site. Transvaginal color duplex ultrasound plays a crucial role in detecting uterine vascular abnormalities as a cause of post-abortion or secondary postpartum hemorrhage and can help differentiate the pathologies responsible for the abnormal vascular pattern, which is highly recommended to optimize patient management.

Uterine Arteriovenous Malformation, Grey- Scale and Colour Doppler findings: A Case Report and Review

Introduction: Uterine arteriovenous malformations can either be congenital or acquired and are rare vascular disorders seen in women of child bearing age, with varied presentation. The clinical features range from being asymptomatic to life threatening haemorrhage. Imaging, particularly grey scale and color Doppler ultrasonography play a major role in the prompt diagnosis of this condition as the findings are useful when differentiating between the types as well as in planning the management of these patients. Objectives: To make a report of a rare case of arteriovenous malformation of the uterus in a young female patient with a review of relevant literature as well as to highlight the importance of Colour Doppler ultrasonography in the evaluation of uterine lesions. Case Presentation: The case is of a 36year old female patient with a 2 years history of amenorrhoea following multiple sessions of dilatation and curettage. She also had chemotherapy due to choriocarcinoma. Pregnancy test was negative. Pelvic ultrasound scan done showed multiple cystic tubular spaces that were hypervascular on colour Doppler interrogation. High velocities and low RI values were recorded. Conclusion: Uterine arteriovenous malformations (AVMs) are important rare vascular disorders of the uterine vessels that need to be recognized early on imaging for appropriate management to be instituted.

Артериовенозная мальформация нижней носовой раковины у ребенка: клинический случай

Congenital arteriovenous malformations (AVMs) of the head and neck are not common in clinical practice. They may have various manifestations — from minor aesthetic changes to severe hemodynamic disorders. Diagnosis and treatment of AVM is a difficult task. Atypical structure of the vascular wall can provoke intense intraoperative bleeding, and incomplete removal of the neoplasm leads to a high risk of tumor recurrence. The clinical observation under review presents a rare case of AVM of the inferior nasal basin in a 5-year-old child who initially presented to the hospital with nasal bleeding. Surgical method is the only way of radical treatment of AVM. We chose the safest minimally invasive technique — endonasal endoscopic approach that allowed total removal of the AVM without hemorrhagic complications.

ПРАВОСТОРОННІЙ ГЕМОТОРАКС ЯК НАСЛІДОК АРТЕРІОВЕНОЗНОЇ МАЛЬФОРМАЦІЇ ЛЕГЕНЬ

Arteriovenous malformation of lung is a condition characterized by a direct connection of pulmonary artery system arteries with pulmonary veins and intrapulmonary right-to-left bypass formation. The prevalence of arteriovenous malformation is 1 per 50 000, observed more often in women. About 10 % of cases are diagnosed in childhood with the next rise of morbidity at the age of 50-60 years. Etiology is not studied yet. Clinical picture of arteriovenous malformation depends on a diameter of vessels, responsible for the bypass of blood. The most serious complication of arteriovenous malformation is a hemoptysis (pulmonary hemorrhage), hemothorax, abscess and brain infarction. Radiological methods, mainly spiral computed tomography of lung vessels, are the mainstay of diagnosis. Management of arteriovenous malformation is done using embolization of arterial vessels of affected area, resection of lung or combination of these methods. We present the clinical case of arteriovenous malformation, complicated by hemothorax. Key words: arteriovenous malformation, hemothorax, congenital hemorrhagic telangiectasia, video-assisted thoracoscopy, thoracic cavity computed tomography.

Clinical case of arteriovenous malformation of the uterus after trophoblastic disease

Clinical case of arteriovenous malformation of the uterus after trophoblastic disease

An Arteriovenous Malformation of the External Ear in the Pediatric Population: A Case Report

Arteriovenous malformation (AVM) results from errors in vascular development during embryogenesis; absent capillary beds lead to shunting directly from the arterial to venous circulation. Although it is common in the head and neck region, Arteriovenous malformations (AVM) of the external ear are relatively uncommon lesions. They typically present during childhood. We report a case of giant AVM of the right pinna in 8 years child, which are very rarely seen. We discussing the definition, clinical findings, diagnostic approaches of arteriovenous malformations.

Rare cause of bilateral basal ganglia calcifications: hemispheric AVM

BackgroundIntracranial calcifications may occur physiologically or pathologically for many reasons. In arteriovenous malformations (AVMs), calcification is not uncommon and is usually detected in the lesion vessel walls and surrounding parenchyma. However, rarely calcifications can also be seen in bilateral basal ganglia and especially in watershed areas, which are far from the lesion.Case presentationIn this article, we present a 47-year-old case of hemispheric AVM accompanied by bilateral basal ganglia calcification.ConclusionsSince the direct diagnosis of AVM in non-contrast brain-computed tomography (CT) is difficult, the detection of calcification in these regions requires the presence of AVM in the differential diagnosis.

Re-rupture in ruptured brain arteriovenous malformations: a retrospective cohort study based on a nationwide multicenter prospective registry

BackgroundThis study aimed to investigate the natural history of re-rupture in ruptured brain arteriovenous malformations (AVMs) and to provide comprehensive insights into its associated factors and prevention.MethodsThis study included 1712...

Repair of Isthmocele Following Embolization of Uterine Arteriovenous Malformation

To present a case of concurrent uterine arteriovenous malformation (AVM) and isthmocele, treated with ethylene vinyl alcohol copolymer (EVAC) embolization of the AVM followed by robotic isthmocele repair. A stepwise video demonstration with narration. A tertiary care academic hospital. Patient is a 37-year-old with one previous cesarean section who presented with persistent heavy vaginal bleeding after a dilation and evacuation procedure. Imaging showed evidence of an isthmocele and an iatrogenic uterine AVM secondary to the dilation and evacuation procedure. Both entities are morbid conditions associated with significant operative blood loss. Embolization of the acquired AVM was first performed to stabilize bleeding. In addition, owing to the extensive uterine defect and history of infertility, surgical repair of the isthmocele was recommended. A multidisciplinary approach combining interventional radiology and gynecologic surgery expertise, implementing several strategies to minimize blood loss: 1. Image-guided uterine AVM embolization with EVAC [1] 2. Hysteroscopic identification of isthmocele and residual EVAC in the cavity, with fluorescence transillumination to clearly delineate isthmocele borders 3. Robot-assisted laparoscopic approach for bladder flap creation, as well as retroperitoneal space dissection to skeletonize uterine arteries 4. Transient occlusion of uterine arteries using vascular clamps to minimize operative blood loss given the isthmocele size and its proximity to the left uterine artery 5. Resection of the isthmocele and removal of residual intracavitary EVAC 6. Multilayer, bidirectional hysterotomy closure and vascular clamp removal to restore uterine blood supply CONCLUSIONS: Successful multidisciplinary treatment of concurrent uterine AVM and isthmocele. Cesarean delivery at 36 to 37 weeks' gestational age was recommended for future deliveries.

Evaluating the safety and efficacy of transvenous embolization for brain arteriovenous malformation: A systematic review and meta-analysis.

Transvenous embolization is a potential therapy for brain arteriovenous malformation, involving the use of microcatheters to guide an ethylene vinyl alcohol coil for vessel occlusion. However, the safety and efficacy of transvenous embolization are not fully established. To evaluate the safety and efficacy of transvenous embolization for brain arteriovenous malformation. A systematic review of the literature of studies investigating the safety and efficacy of transvenous embolization for brain arteriovenous malformation was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases, including PubMed, Cochrane Library, Web of Science, and Embase were queried. In the final analysis of 16 studies involving 368 brain arteriovenous malformation cases who received transvenous embolization, the complete occlusion was achieved in 91% (95% CI: 88%, 94%; I2 = 43%, p = 0.04) of cases. The overall rate of good outcomes after discharge was high at 89% (95% CI: 82%, 95%; I2 = 60%, p < 0.01). Ischemic complications were reported in 1% of cases (95% CI: 0%, 2%; I2 = 0%, p = 0.96), while hemorrhagic complications occurred in 6% of cases (95% CI: 3%, 8%; I2 = 8%, p = 0.37), and technical complications rate of 8% (95% CI: 4%, 11%; I2 = 8%, p = 0.36). Finally, only one death was related to the procedure. Transvenous embolization for brain arteriovenous malformation shows promising safety and effectiveness, with low mortality, a considerable rate of positive outcomes, and a relatively low incidence of complications. The majority of patients achieved complete occlusion, indicating transvenous embolization as a potential option, especially for challenging deep-seated lesions.

Uterine Arteriovenous Malformation: A Near-Missed Fatal Misdiagnosis?

Less than 100 cases of uterine arteriovenous malformations (AVM) have been documented. The true incidence remains unknown with 30% complicated by hypovolemic shock. Women who experience unexplained vaginal bleeding may consider this diagnosis. We chose to emphasize this case because, while being a rare disease, it could cause mortality if misdiagnosed. In this case, a 23-year-old lady, para 1+2 with a history of several miscarriages and curettage, complained of per vaginal bleeding more than 2 months after her suction and curettage on September 2018. Her second visit was managed as having retained product of conception and another curettage was conducted. Despite this, the patient still has worsening vaginal bleeding which leads to her third visit. A bedside ultrasound was conducted and suspected uterine AVM. This was then further confirmed with contrast-enhanced computed tomography of the pelvis and pelvis angiography. Five Micronester coils and 10% Histoacryl adhesive were used to successfully embolize the uterine artery. This case report served as a valuable lesson on the importance of having a proper diagnosis and prompt treatment to avoid fatal misdiagnosis which could have disastrous consequences.

Ischemic stroke in a young adult with a known epileptogenic arteriovenous malformation: illustrative case.

Brain arteriovenous malformations (AVMs) usually manifest as hemorrhages or seizures. They rarely present with ischemic symptoms, especially in young patients. We present a case of an epileptogenic AVM that led to cerebral infarction due to paradoxical embolic occlusion of the middle cerebral artery (MCA) involving the main feeder of the lesion. A 35-year-old male had been suffering from AVM-associated epilepsy for 10 years and was scheduled for surgery. He suddenly developed right-sided hemiconvulsions followed by hemiparalysis and impaired consciousness. Computed tomography revealed no intracerebral hemorrhage, and symptoms were initially thought to indicate epilepsy and Todd's palsy. Because of his prolonged symptoms, he underwent magnetic resonance imaging, which revealed a large cerebral infarction due to occlusion of the MCA involving the main feeder of the AVM. The patient underwent AVM resection, and the partially thrombosed nidus was completely removed. Histopathological investigation revealed a fresh thrombus in totally occluded nonarteriosclerotic feeders. He had no atrial fibrillation; however, subsequent transesophageal echocardiography revealed a patent foramen ovale, suggesting a paradoxical embolism. This case serves as a reminder that AVMs can present with considerable variability. Acute cerebral infarction should be considered a possible mechanism of seizures, even in patients with epileptogenic AVM.

Spinal arteriovenous malformation with a calcified nodule: illustrative case.

This article describes a rare case of cervical spinal arteriovenous malformation (AVM) mimicking a neurogenic spinal tumor. A 22-year-old female presenting with a C6-7 AVM with a calcification nodule experienced new-onset acute right upper radiculopathy associated with extradural compression of the spinal cord. Note that spinal AVMs with a calcified nodule are rare. Endovascular embolization is generally used to relieve the symptoms of AVM; however, this procedure cannot relieve cord compression, particularly in cases complicated by calcified nodules. This article discusses treatment options. Decompression surgery is preferable to endovascular embolization because it alleviates symptoms while preventing cord compression and minimizing the risk of recurrence.

A Success Story of Cerebral Arteriovenous Malformation (AVM) Treated with Stereotactic Radiosurgery (SRS) in Bangladesh

Purpose: To share a case of cerebral Arteriovenous Malformation (AVM) patient, treated with Stereotactic Radiosurgery (SRS) at Evercare Hospital Dhaka, treatment process and successful outcome. Background: Arteriovenous malformation is an anomaly, mostly congenital due to a misfit in vasculogenic, where arteries and veins come to a direct connection. Treatment options include observation, embolization, microsurgery, Stereotactic Radiosurgery (SRS) either alone or in combination. This report describes our experience in treating a patient of AVM by SRS. Stereotactic Radiosurgery is an established modality to achieve desired nidus obliteration, excellent compliance being noninvasive, and reduced treatment-related morbidity. This case report also reviewed the literature in detail. After a thorough literature search, to the best of our knowledge, this shall be the first published case report of AVM successfully treated with SRS in Bangladesh. Case Presentation: In March 2019, 25-years old male presented in Radiation Oncology OPD as a diagnosed case of AVM, having complaints of headache for two years. Headache was occasional and often associated with vertigo and dizziness. He had no neurologic deficit. A radiological assessment revealed a large (4.6x4.4cm) AVM in the left parieto-occipital lobe showing serpiginous enhancement with IV contrast. After routine workup, he underwent stereotactic Radiosurgery in March’2019. A dose of 23Gy was delivered to the malformation, including all nidus. Acute radiation toxicity was noted as transient hair loss only over the irradiated area and no other side effect. Radiological Assessment was done at six months, 1year, and 2.5 years. After having a stable size at six months, complete nidus obliteration was achieved at one year. His last visit to our OPD was in July 2021, with radiologically complete nidus obliteration without any significant clinical symptoms. Conclusions: Linear Accelerator-based SRS is an excellent treatment option for AVM, encouraging clinical outcomes for carefully selected patients. Bang. J Neurosurgery 2022; 12(1): 53-64

Partial Onyx embolization triggers spontaneous regression of cerebral AVM: A case report

Spontaneous regression of a cerebral arteriovenous malformations (AVMs) is a rare and poorly understood phenomenon. We present a case of unruptured cerebral AVM in a patient presenting with intermittent headache. In order to reduce hemorrhagic risk, the patient underwent partial embolization of the AVM with Onyx glue. Follow-up digital subtraction angiography (DSA) showed complete obliteration of the residual AVM three months after the treatment. In conclusion, partial Onyx embolization of cerebral AVM may be an etiological factor of spontaneous regression. In order to reduce hemorrhagic risk, targeted partial embolization of the AVM may be an alternative treatment for some cases.

Uterine venous malformations in the puerperium: 2 Atypical cases and literature review.

Uterine arteriovenous malformations (AVMs) is a rare but high-risk cause of uterine bleeding. The clinical management of this condition is challenging, as the ultrasound picture can sometimes be unambiguously interpreted. Moreover, in the puerperium in which acquired AVMs are most frequently formed, it is necessary to discuss the correct management in a multidisciplinary and personalized manner. We present two cases of AVMs developing in the puerperium, both with a vaginal delivery and spontaneous and complete secondment. The symptom of onset was an episode of bright red blood loss in the puerperium, on the 14th and 21st postpartum days, respectively. Transvaginal ultrasound showed a hypervascularized lesion in the myometrium with turbulent vascular flow, confirmed by transabdominal ultrasound and angiography. To date, there are no guidelines on the management of MAVs. In our cases we opted for a conservative approach, in order to preserve the fertility of the patient. These experiences reported have the purpose of enriching a literature still sparse on the subject and in the future to be able to represent a fulcrum for official recommendations.

Retroperitoneal capillary arteriovenous malformation mimicking a malignant neoplasm

IntroductionRetroperitoneal tumors account for 0.2% of all neoplasms. Among these tumors, retroperitoneal vascular malformations are particularly rare, with most previously reported cases being venous malformations.Case presentationA 72‐year‐old woman was diagnosed with a retroperitoneal tumor on abdominal computed tomography. The 27‐mm diameter tumor was located away from the right kidney and major vessels in the right perirenal adipose tissue. Contrast‐enhanced computed tomography revealed a heterogeneously enhanced tumor with well‐defined borders. Dynamic contrast‐enhanced magnetic resonance imaging revealed rapid enhancement in the arterial phase and a progressive filling‐in pattern in the delayed phase. Although vascular malformation was suspected, a definitive diagnosis could not be established. The retroperitoneal tumor was excised laparoscopically for therapeutic and diagnostic purposes, and the histopathological diagnosis confirmed it as a capillary arteriovenous malformation.ConclusionHerein, we presented a rare case of retroperitoneal capillary arteriovenous malformation that was difficult to definitively diagnose preoperatively.