Pembimbing:

dr. Sri Lilijanti W, Sp.A

Arterio Venous Malformation
(AVM)
Oleh:
Khodijah Yahya
Dwi Prasetyo N.
M. Abdul Basith
Wildan Syamsuddin F.
Syamsudduha
Overview
Arteriovenous Malformation
(AVM) are abnormal
connections between arteries
and veins that are congenital
(present at birth).
They don't have the normal
network of tiny vessels
(capillaries) that normally connect
arteries and veins.
AVMs are more common in the
brain than in other regions.
The cause of AVMs is unknown.
What is an AVM?
NORMALLY: Blood flows
from the heart through
large arteries to all areas
of the body.
The arteries branch and
get smaller until they
become a capillary.
The capilarry bed is
where the blood
exchange oxygen and
nutrients with the body
tissue and pick up waste.
The blood travels from
the capillary bed back to
the heart through veins
What is an AVM?
IN AVM: Arteries connect directly to veins without
capillary bed in between.
This create a problem called a high pressure shunt
or fistula.
Veins are not able to handle the pressure of the
blood coming directly from the arteries.
The veins stretch and enlarge as they try to accept
the extra blood.
The weakened blood vessels can rupture and bleed
and also more likely to develop an aneurysms.
How common are AVM?
They occur approximately once in
every 500 births.
AVM are relatively rare birth
defect.
What causes AVM?
Unknown
No known food,
medication, or
activity during
pregnancy can
cause an AVM.
They are believed to be
caused by a mistake in the
formation of the normal
connections between
arteries, veins and
capillaries that occurs during
early embryonic life.
What are the symptoms of AVM?
AVM develop before birth. Usually an AVM is seen as an
innocent stain on your childs skin at birth; often they begin
to enlarge in childhood and adolescence.
Intracranial (within the head) AVM have no visible
symptoms. However, they may cause headaches or
sudden bleeding into the brain.
AVM outside the brain appear more slowly with color
changes, then bleeding and persistent pain.
Cont..
AVM can occur in any organ in
the body. The occur most
frequently in the parts of the
body below (in order of
frequency):
Head
Limbs
Trunk
Internal organs
In time, if the blood flow
through an AVM is
excessive, your childs
heart can become
overworked.
Cont..
In infancy and childhood,
the blush of an AVM can
be mistaken for
hemangioma (the most
common tumor in
babies).
The AVM becomes obvious
as signs of fast blood flow
appear. The skin becomes
a darker red or purple
color, nearby veins enlarge
a mass appears beneath
the stain, and there is local
warmth.
What problems are associated with
AVM?
Hereditary
hemorrhagic
telangiectasia (HHT)
A fairly common familiar
vascular disorder. Children
with HHT can develop
AVMs in the lungs, brain,
and gastrointestinal track.
Parkes Weber syndrome
In this disorder, several
AVMs plus overgrowth of a
limb combine to put extra
strain on the heart.
Our research
collaborators have
identified a gene that
is changed in about
one half of the patients
with this syndrome.
Wyburn-Mason
syndrome (Bonnet-
Dechaume-Blanc
syndrome)
A rare combination of a
vascular abnormality in the
retina and an AVM in the
brain.
Its sometimes
accompanied by a
facial capillary stain
and/or overgrowth on
one side of the body.
Cobb syndrome
The combination of a
cavernous malformation
(fragile arteries/veins) of
the skin with an AVM of
the spinal cord.
How are AVM diagnosed?
After the exam, your childs doctor will probably want to do one or more of
the following procedures:
Ultrasonography (USG)
To detect the rapid
flow of blood through
an AVM.
Magnetic resonance
imaging (MRI) This
test gives the most
information about the
extent of the anomaly.
Angiography The most
precise test to see the
details of the AVM. Your
childs doctor will inject a
contrast dye that can be
seen by x-ray fluoroscopy
into the AVM via a flexible
tube that is usually inserted
in your childs groin.
Your childs doctor may be able to tell with a physical examination of your child.
Around the area of the AVM, the skin is warm and, in time, the pulsation of blood
flow can be felt.
How are AVM treated?
Treatment often depends on where your childs AVM is located.
Intracranial AVMs
Radiation
Embolization (injection of material into the center of the anomaly via a
catheter)
Surgery
AVMs in other parts of the body
Embolization
Sclerotherapy (direct injection of an irritating solution)
Surgery
Wherever possible, surgery provides the best treatment.