Type:
Educational Exhibit
Keywords:
Head and neck, Interventional vascular, Neuroradiology brain, Catheter arteriography, Fluoroscopy, Catheter venography, Embolisation, Diagnostic procedure, Arterial access, Arteriovenous malformations, Fistula, Education and training
Authors:
X. S. Herdoíza Salinas1, P. A. CUASPUD 2, P. M. Cornejo2, J. Nieto2; 1Quito, Pichincha/EC, 2QUITO/EC
DOI:
10.26044/ecr2019/C-3294
Background
Arteriovenous malformations (AVM) are shunt-like lesions between high flow nutrition arteries and drainage veins with a nest of anomalous vessels,
whose pathogenesis is not well understood(1). They are generally believed to be developmental lesions or to be acquired.
Many theories have been suggested.
For example,
the retention of the primordial arteriovenous connections from fetal intracranial vasculature or failure of development of an intervening capillary network.
Also has been postulated that a disturbed venous drainage system is the primary abnormality in AVM pathogenesis,
with an increases intraluminal pressure,
reduced tissue perfusion,
and result in diapedetic hemorrhage(2).
Different classification systems have been proposed. The most widely accepted classification of cerebrovascular malformations was proposed by McCormick (neurovascular surgery),
wherein a global way,
we can separate vascular lesions into classic AVMs,
which may be either pial or dural fistulae,
depending on the location of the shunt; cavernous hemangiomas (or cavernomas); capillary telangiectasia and developmental venous anomalies (DVAs)(3).
Many vascular lesions can manifest with an abnormal vessel in the brain imaging,
it´s important to differentiate from one another due to their different treatment strategies and natural history.
Classis brain AVMs and pial arteriovenous fistulas (AVFs) should be managed to reduce their risk associated.with the disease versus treatment-related risk,
DVAs never require treatment and dural AVFs with cortical venous reflux always require treatment(4).
Like any vascular lesion of the brain,
an AVM represents a diagnostic and treatment challenge.
The morbidity and mortality of classic cerebral arteriovenous malformations are mainly due to hemorrhage; all therapeutic efforts are focused on obliterating the lesion and reducing the bleeding risk.