Case Of Arteriovenous Malformation Research Articles

Renal Arteriovenous Malformations- A Rare Vascular Cause of Back Pain

Renal arteriovenous malformation (AVM) is a very rare phenomenon. Fewer than 200 cases have been reported in the literature. They most commonly present with hematuria in young women. Renal AVMs may be cirsoid (multibranched) or cavernous. Cirsoid morphology predominates 3:1. Historical treatment is surgical requiring partial or total nephrectomy. More recently endovascular techniques have been employed effectively. We present 2 cases of large renal AVMs treated with single Amplatzer plug embolization.

Successful Treatment of Pancreatic Arteriovenous Malformation with External Beam Radiotherapy

Pancreatic arteriovenous malformation (AVM) is a rare disease that occurs worldwide, but only a few sporadic cases have been reported in Taiwan. The poor definition of pancreatic AVM has been the major obstacle in its diagnosis. Conventionally, angiography and CT scans are used to diagnose pancreatic AVM. Here we report a case of pancreatic AVM that was initially disclosed by endoscopic ultrasound (EUS) and confirmed by angiography. In this case report, we will also present the very good response of pancreatic AVM to external beam radiotherapy.

A successful treatment with transcatheter arterial embolization for arteriovenous malformation of pancreas

Aims: Arteriovenous malformation (AVM) of pancreas is an extremely rare condition. In most cases, the patients are asymptomatic to be diagnosed incidentally, and tumorous mass is revealed in an imaging investigation performed for a different reason. The AVM of pancreas present with a wide spectrum of symptoms and it can be accompanied sometimes by fatal complications as like catastrophic bleeding. Traditionally surgery has been considered the treatment of choice, however, alternative approaches, such as transcatheter arterial embolization (TAE), may be a better choice in selected case. Methods: A 50-year-old man visited our hospital due to AVM of pancreas which was detected incidentally in general health examination. He had no history of trauma, pancreatitis, or other systemic disease. In the clinical examination, there were no specific clinical findings, related to pancreatic mass. The abdominal CT and MRI revealed pancreatic AVM with 5 cm sized multi-lobulated, hypervascular mass in pancreas body. Results: For the treatment, TAE was planned instead of surgery. Selective catheterization for feeding branches from proper hepatic artery was performed, and then, TAE was done in dorsal pancreatic artery by interlock coil. In follow-up dynamic enhanced CT, we confirmed the change of attenuation of hypervascular staining of the mass in pancreas body. The patient discharged without any complication after one week following TAE. Conclusions: Herein, we report a case of asymptomatic AVM of pancreas treated with TAE successfully.

A case of arteriovenous malformation of pancreas treated with transcatheter arterial embolization

A case of arteriovenous malformation of pancreas treated with transcatheter arterial embolization

An Unusual Case of Acquired Uterine Arteriovenous Malformation With Persistent Scar Ectopic Pregnancy Successfully Managed With Uterine Artery Embolization

Uterine arteriovenous malformation (AVM) is a rare entity in gynecology, with fewer than 100 cases reported in the literature. AVM is an abnormal arteriovenous connection lacking an intervening capillary network on histopathological examination. We report an unusual case of acquired AVM after dilatation and curettage of cesarean scar ectopic pregnancy managed with uterine artery embolization and concurrent methotrexate administration for persistently elevated beta-human chorionic gonadotropin levels. J Med Cases. 2016;7(4):143-147 doi: http://dx.doi.org/10.14740/jmc2458w

Coexistent arteriovenous malformation and hippocampal sclerosis

Cavernous angiomas or cavernomas have been occasionally described in patients presenting with medically intractable epilepsy. Reports of cavernomas associated with a second pathology potentially causative of seizures have rarely been documented; most commonly, the second pathology is focal cortical dysplasia or less frequently, hippocampal sclerosis. To our knowledge, cases of arteriovenous malformation arising in this clinical setting and associated with hippocampal sclerosis have not been previously described. We report a 56-year-old woman who initially presented at age 24years with staring spells. Imaging studies revealed an arteriovenous malformation in the right parietal lobe. At age 51years, she represented with signs and symptoms related to a hemorrhage from the malformation. The patient underwent Gamma Knife radiosurgery (Elekta AB, Stockholm, Sweden) of the lesion. She subsequently developed seizures, refractory to medical management. MRI studies showed atrophy in the right hippocampus. She underwent resection of the right parietal lobe and hippocampus. Histopathologic examination of the right parietal lesion revealed an arteriovenous malformation marked by focally prominent vascular sclerosis, calcification and adjacent hemosiderin deposition. The hippocampus was marked by prominent neuronal loss and gliosis in the CA1 region, consistent with CA1 sclerosis or hippocampal sclerosis International League Against Epilepsy type 2.

Pediatric spinal arteriovenous malformations and fistulas: a single institute’s experience

Pediatric spinal vascular diseases are extremely rare. We aimed to evaluate their clinical characteristics and treatment outcomes in our institute. A total of 10 patient files were retrospectively reviewed, including 3 cases of intramedullary arteriovenous malformations (AVMs), 6 cases of perimedullary arteriovenous fistulas (AVFs), and 1 case of epidural AVF. Clinical features, radiological findings, treatment results, and clinical outcomes were evaluated. The median durations of the radiologic and clinical follow-ups were 17.7 and 107.9months, respectively. The male to female ratio was 1:1, with a median age at diagnosis of 9years. All AVMs were juvenile type, all perimedullary AVFs were high flow types (three type IVb and three type IVc), and one epidural AVF was associated with intradural venous drainage. Most cases (90%) were located in the cervical spine and conus medullaris. Acute neurological deterioration was identified in five patients; however, bleeding was identified in only one patient. Two cases were surgically treated, seven cases underwent embolization, and one case underwent radiosurgery. Three cases were completely obliterated, and their clinical states were improved (n=2; 66.7%) and stationary (n=1; 33.3%). Meanwhile, seven cases were incompletely obliterated, and their clinical states were improved (n=2; 28.6%), stationary (n=3; 42.8%), and aggravated (n=2; 28.6%). Pediatric spinal AVMs and AVFs were mostly complex and high flow types, and complete obliteration could not be satisfactorily achieved. Incompletely treated lesions should be closely followed up because they may worsen.

De novo development of a cerebral arteriovenous malformation following radiation therapy: Case report and an update to classical arteriovenous malformation nomenclature

Cerebral arteriovenous malformations (AVM) are traditionally considered primary congenital lesions that result from embryological aberrations in vasculogenesis. Recent insights, however, suggest that these lesions may be secondary to a vascular insult such as ischemia or trauma. Herein, the authors present a rare case of a secondary cerebral AVM, occurring in a young girl who received prior cranial radiation therapy. At age 3years, she underwent surgical resection, chemotherapy, and photon radiation therapy for treatment of a fourth ventricular ependymoma. At age 19years, she developed new onset seizures and was found to have a left medial temporal lobe AVM. Her seizures were managed successfully with anti-epileptic medications and the AVM was treated with proton radiation therapy. This case highlights a rare but possible vascular sequela of radiation therapy and adds to the growing body of evidence that cerebral AVM may arise as secondary lesions.

Clinical analysis of microsurgical treatment of giant intracranial arteriovenous malformations

To explore the clinical features and microsurgical treatment strategies of giant intracranial arteriovenous malformations (AVM). A total of 15 cases of giant intracranial AVM treated with microsurgery were analyzed retrospectively. According to the Spetzler-Martin grade, there were 4 cases of grade Ⅳ, 11 cases of grade Ⅴ. Pre-operative endovascular embolizations were carried out in 3 AVMs. All the included patients were confirmed as giant intracranial AVM by magnetic resonance angiography (MRA), digital subtraction angiography (DSA), 3-dimensional CT angiography (3D-CTA) before surgery. All the resected tissues were sent for pathological examination, and the diagnoses were confirmed as AVM. The average operation time of the 15 patients was 10.3 ±6.9 hours. After 1-3 months, all the patients were rechecked by DSA, the large vascular malformations in 12 cases were completely resected, 3 cases had a small amount of residual further treated with gamma knife treatment. Magnetic resonance imaging (MRI) and MRA examination indicated that the residual AVM was occluded after 12 months. Patients were followed up at 6, 12 and 24 months after operation, and assessed by Glasgow outcome scale (GOS) score: 13 cases good, 1 cases mild disability, 1 cases severe disability; the good rate was 86.6%, with no dead case. Sufficiently preoperative preparation, appropriate operative methods and skills are necessary to treat giant intracranial arteriovenous malformation.

Expectant management of a case of uterine arteriovenous malformation with an ovarian artery aneurysm

Uterine arteriovenous malformations are rare and their true prevalence is unknown. Selective arterial embolization is used as first-line therapy for acute severe vaginal hemorrhage associated with uterine arteriovenous malformations. However, some patients with no vaginal bleeding have been treated conservatively, so the optimal treatment modality for arteriovenous malformations is unclear. We describe a 58-year-old woman with uterine arteriovenous malformation and an ovarian artery aneurysm who was successfully treated with an expectant management approach along with an assessment of age, symptoms, and imaging findings.

Arteriovenous malformation of the pancreas: a case report.

Arteriovenous malformation (AVM) of the pancreas is uncommon in the gastrointestinal tract. We present a case of AVM of the pancreatic head in a 59-year-old male. He was admitted to a hospital with hematemesis and tarry stool and referred to our hospital in March 2014 on the diagnosis of pancreatic artery pseudoaneurysm. A computed tomography scan showed the presence of irregular dilated and/or stenotic vessels with meandering in the pancreatic head. Magnetic resonance imaging showed strong enhancement of the conglomeration in the pancreatic head. Selective angiography showed the proliferation of a vascular network in the pancreatic head and an early visualization of the portal vein at the arterial phase. The patient qualified for surgery with a preoperative diagnosis of AVM of the pancreatic head. We performed pylorus-preserving pancreaticoduodenectomy. The histological results confirmed the presence of irregular dilated tortuous arteries and veins in the pancreatic head. Surgical treatment may represent definitive management of symptomatic AVM.

大量歯肉出血を繰り返した顎顔面動静脈奇形の1例

Arteriovenous malformation (AVM) is rare in the oral and maxillofacial region, and it is often difficult to manage associated hemorrhage. We report a case of broad AVM in the maxillofacial region that occurred suddenly and was associated with frequent intraoral hemorrhages on the eruption of milk teeth and threatened the patient’s life.

Outcomes of Surgical Treatment of Vascular Anomalies on the Vermilion.

BackgroundThe vermilion plays an important role in both the aesthetic and functional aspects of facial anatomy. Due to its structural features, the complete excision of vascular anomalies on the vermilion is challenging, making it difficult to determine the appropriate treatment strategy. Thus, the authors analyzed the results of surgical treatment of vascular anomalies on the vermilion.MethodsThe medical records of 38 patients with vascular anomalies on the vermilion who underwent surgery from 1995 to 2013 were analyzed. Nine of the cases had an involuted hemangioma, and 29 cases had a vascular malformation; of the vascular malformations, 13, 11, one, and four cases involved were capillary malformations (CMs), venous malformations (VMs), lymphatic malformations (LMs), and arteriovenous malformations (AVMs), respectively. We investigated the surgical methods used to treat these patients, the quantity of surgical procedures, complications and instances of recurrence, and self-assessed satisfaction scores.ResultsA total of 50 operations were carried out: 28 horizontal partial excisions, eight vertical partial excisions, and 14 operations using other surgical methods. All cases of AVM underwent complete excision. Six cases experienced minor complications and one case of recurrence was observed. The overall average satisfaction score was 4.1 out of 5, while the satisfaction scores associated with each lesion type were 4.2 for hemangiomas, 3.9 for CMs, 4.2 for VMs, 5.0 for LMs, and 4.0 for AVMs.ConclusionsIt is difficult to completely excise vascular anomalies that involve the vermilion. This study suggests that partial excision focused on correcting the overall contour of the lips is effective and leads to satisfactory results.

Role of histochemical stains in differentiating hemangioma and vascular malformation

Background: Benign vascular lesions such as vascular malformation and hemangioma at times pose difficulty in diagnosis both for clinicians and pathologists. Vascular malformations are difficult to treat while hemangiomas resolve spontaneously in most instances. There are instances when vascular malformations, especially arteriovenous malformations (AVMs) have been misdiagnosed as hemangiomas and vice-versa. Clinical and radiological correlation with histopathological confirmation of these anomalies is important for the management of these lesionsAim: The aim was to study the histological characteristics of hemangiomas and vascular malformations and to study the utility of histochemical stains in their diagnosis. Materials and Methods: We retrospectively studied fifty cases retrieved from the records of Department of Pathology which were diagnosed as hemangioma (n=32) and vascular malformation (n=18) on Hematoxylin and Eosin (H and E) stain over a period of 18 months. The cases were analyzed based on findings of histochemical stains such as Verhoeff-van Gieson (VVG), Masson's trichrome (MT), and toluidine blue. Results: After reviewing all the cases with the use of histochemical stains, two of the three cases originally diagnosed as hemangioma turned out to be AVM and one to be venous malformation. An increased number of intra-lesional nerves were found in 16 of 19 cases of AVM and in both cases of venous and lymphatic malformation. Hemangiomas did not show increase in nerve bundles. Mast cells were found to be increased in proliferating hemangiomas and pyogenic granulomas as compared to AVMs. Conclusion: Hemangiomas and vascular malformations should be clearly differentiated to reduce the risk of treatment failure and recurrence. With the use of histochemical stains such as VVG, MT and toluidine blue, the diagnostic difficulty can be reduced and definitive diagnosis is possible.

妊娠中に増悪した舌動静脈奇形の1例

妊娠中に増悪した舌動静脈奇形の1例

Impact of Implementing Cardiac CT in Evaluating Patients Suspected of Cardioembolic Stroke

In practice, clinical and logistic hurdles may hamper performing transesophageal echocardiography in stroke patients. Cardiac computed tomography (CT) is a recently introduced noninvasive modality able to detect various embolic causes. Thus, we retrospectively assessed possible added values of applying cardiac CT in the real-world work-up of suspected cardioembolic stroke cases. Forty-seven patients were neurology service referrals for suspected cardioembolic stroke. The CT images and clinical reports of our cardiac CT radiologists were retrospectively evaluated. Cardiac CT was assessed in terms of detecting major embolic potential findings, potentially significant stroke-unrelated findings, and coronary arterial disease (CAD). Computed tomography results were correlated with echocardiographic reports. Cardiac CT showed findings of major embolic potential in 10 patients (21%, 5 thrombi cases, 2 vasculitis cases, 1 case of metastasis invading the left superior pulmonary artery, 1 myocardial infarction case, and 1 pulmonary arteriovenous malformations case), none of which were documented in echocardiography reports. Two cases (4%) with findings of major embolic potential where identified on echocardiography but not on CT (1 left atrial appendage thrombus and 1 mitral valve vegetation). Computed tomography of 13 patients (28%) showed 16 potentially significant stroke-unrelated findings. Twenty-one patients (47%) had unexpected CAD on CT, 11 (52%) of which were obstructive. Implementing cardiac CT in assessing patients suspected of cardioembolic stroke added value to echocardiographic evaluation, by detecting major embolic potential findings. In addition, cardiac CT revealed additional potentially significant stroke-unrelated findings and CAD.

Medical Treatment of Uterine Arteriovenous Malformations: A Case Report

Background and Aim: Uterine arteriovenous malformation (AVM) is one of the complications of cesarean section and uterine curettage which is life-threatening. The aim of this case report was to assess medical treatment of a symptomatic case of AVM as uncommon cause of vaginal bleeding. Case Report: A 24-year-old female with an episode of heavy vaginal bleeding after curettage of pregnancy first trimester was referred to Ghaem Hospital of Mashhad University of Medical Sciences in 2014. She had a history of elective caesarian section in first pregnancy. Based on clinical findings and color Doppler ultrasonography, uterine AVM was diagnosed and modality conservative medical management was arranged. She was successfully treated with GnRH analogs and she had regular and normal menstrual cycles in her 1 year serial follow-up. Now, she has spent three months of pregnancy after 15 months of her disease. Conclusion: Diagnosis of uterine AVM should be considered in the case of massive uterine vaginal bleeding and a history of prior uterus surgery. The gonadotropin-releasing hormone agonist is useful in this situations. Keywords: Abnormal vaginal bleeding, medical treatment, ultra sonography, uterine arteriovenous malformation.

Pre-existing, incidental and hemorrhagic AVMs in pregnancy and postpartum: Gestational age, morbidity and mortality, management and risk to the fetus.

The objective of this article is to analyze the maternal and fetal outcomes of pregnancies that present with arteriovenous malformations (AVMs). A literature review was performed that analyzed 65 cases of AVM during pregnancy previously reported in English literature. Sixty-five cases of pregnancy-associated AVM were identified. The patients' ages ranged from 16 to 45 years, with a mean of 28 ± 4.9 years. Sixteen cases (24.6%) were pre-existing AVMs. There were 54 cases (83.1%) of AVM ruptured during pregnancy and postpartum: Six cases (11.1%) were in the first trimester, 24 (44.4%) were in the second, 22 (40.7%) were in the third trimester and two (3.7%) were postpartum. Unfavorable maternal clinical outcome (modified Rankin Scale (mRS) ≥ 2) was identified in 20 cases (30.8%) and abortion occurred in 10 cases (15.4%). There were three maternal deaths, yielding a case mortality rate of 4.6%. Fifty-three fetuses were born via cesarean section in 42 cases and vaginal delivery in 10 cases; 48 were in good health, three were temporarily intubated, one was macrosomic and one died. In univariate analysis, AVM hemorrhage presentation was significantly associated with a poor maternal outcome (mRS ≥ 2) (p = 0.030); however, not significantly associated with fetus risk (p = 0.864). Gestational age was not significantly associated with poor maternal outcome (p = 0.875) or fetal risk (p = 0.790). AVM hemorrhage presentation was significantly associated with poor maternal outcome. Pre-existing ruptured AVM may not be associated with fetal risk. Gestational age of AVM rupture was not significantly associated with poor maternal outcome or fetal risk.

A case of severe uterine arteriovenous malformation treated with danazol followed by a transarterial embolization of unilateral uterine and ovarian arteries

Abstract Uterine arteriovenous malformation (AVM) is a potentially life-threatening condition characterized by abrupt and profuse uterine bleeding from abnormal connections between arteries and veins in the myometrium. It is commonly associated with prior pregnancy or uterine trauma. We present a case of severe uterine AVM treated with danazol and transarterial embolization (TAE). A 38-year-old patient with a history of two abortions and a myomectomy was referred to our hospital for intermittent massive uterine bleeding. She was diagnosed with uterine AVM by transvaginal color Doppler ultrasonography and helical computed tomography (CT). Diagnostic three-dimensional CT (3D-CT) angiography clearly demonstrated hypervascular tangles of uterine vessels, feeding arteries, remarkably dilated draining veins, as well as early filling of the internal iliac vein and the inferior vena cava, indicating massive arteriovenous shunting in the uterus. Danazol was administrated for 10 months to reduce the shunting of the uterine AVM before TAE with N-butyl-cyanoacrylate of the left ovarian artery and left uterine artery was successfully performed. After the procedure, we confirmed that shunting through the uterine AVM was markedly reduced. The patient has not experienced any severe uterine bleeding since the treatment.

An Incidental Finding of Severe Hypoxia in an Asymptomatic Patient Caused by Pulmonary Arteriovenous Malformations

SESSION TITLE: Pulmonary Vascular Disease Cases I SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Monday, October 26, 2015 at 11:00 AM - 12:00 PM INTRODUCTION: Pulmonary arteriovenous malformations (AVMs) are a rare clinical entity, especially when found in isolation with no underlying etiology. Literature review suggest that pulmonary AVMs are symptomatic in 91% of cases, with dyspnea in 82% and cyanosis in 79% of patients. Furthermore, 70% are also associated with Osler Weber Rendu Syndrome. We report a case of severe asymptomatic hypoxia, discovered incidentally on routine pre-operative evaluation, found to have isolated multiple large pulmonary AVMs. Workup failed to show any underlying etiology. CASE PRESENTATION: The patient is a 54 year old female, with a history of COPD and severe aortic valve insufficiency, diagnosed via an echocardiogram at another facility, referred to cardiovascular surgery at our hospital. During pre-surgical evaluation, she was found to be hypoxic, with oxygen saturation in the 80%s on 2L of oxygen by nasal cannula and was admitted. Upon admission, her oxygen saturation was at 85% on a non re-breather mask. She denied any symptoms. Physical examination was unremarkable. Laboratory values showed hemoglobin of 17.3g/L and hematocrit of 48.9%. Chest X-Ray revealed a mass like density in the right lower lobe (RLL). CT scan of the thorax with contrast was negative for pulmonary embolus but 4 AVMs in RLL and 2 in right upper lobe were identified. Further questioning and workup was negative for Osler-Weber-Rendu syndrome or other underlying etiology. Resting echo showed an EF of 70% and a Bubble Echocardiogram revealed extensive right to left shunting. Bubbles entered from the pulmonary venous drainage into the left atrium consistent with AVMs. She had a pulmonary angiogram and AVMs of the RLL were embolizedx2 and an amplatzer vascular occlusion plug was deployedx2. After embolization, the patient's oxygen saturation was at 95% on 6L of oxygen. A Transesophageal Echo showed moderate aortic insufficiency and she decided to forego cardiac surgery. DISCUSSION: Studies show most cases of pulmonary AVMs have an underlying etiology and are symptomatic in 91% of patients. Our case represents a patient with large asymptomatic pulmonary AVMs with no underlying etiology. CONCLUSIONS: It shows that in patients presenting with hypoxia with no clear underlying cause, pulmonary AVMs can be considered as a cause and that pulmonary angiogram and embolization of AVMS is the cornerstone of treatment of pulmonary AVMs. Reference #1: Faughnan ME, LUI YW, Wirth JA, et al. Diffuse Pulmonary arteriovenous malformations: characteristics and prognosis. Chest 2000; 117:31 DISCLOSURE: The following authors have nothing to disclose: Asad Omar No Product/Research Disclosure Information