Anarteriovenous malformation (AVM) is an abnormal connection betweenarteries andveins, bypassing thecapillary system. Usuallycongenital, thisvascular anomaly is widely known because of its occurrence in thecentral nervous system (usually as acerebral AVM), but can appear anywhere in the body. The symptoms of AVMs can range from none at all to intense pain or bleeding, and they can lead to other serious medical problems.[1]
Symptoms of AVMs vary according to their location. Mostneurological AVMs produce few to no symptoms. Often the malformation is discovered as part of anautopsy or during treatment of an unrelated disorder (an "incidental finding"); in rare cases, its expansion or a micro-bleed from an AVM in the brain can causeepilepsy,neurological deficit, or pain.[2]
The most general symptoms of acerebral AVM includeheadaches and epilepticseizures, with more specific symptoms that normally depend on its location and the individual, including:[1]
Acute onset of severe headache. May be described as the worst headache of the patient's life. Depending on the location of bleeding, may be associated with new fixed neurologic deficit. In unruptured brain AVMs, the risk of spontaneous bleeding may be as low as 1% per year. After a first rupture, the annual bleeding risk may increase to more than 5%.[3]
Seizure or brain seizure (46%). Depending on the place of the AVM, it can contribute toloss of vision.
Headache (34%)
Progressive neurologic deficit (21%)
May be caused by mass effect or venous dilations. Presence and nature of the deficit depends on location of the lesion and the draining veins.[4]
Pulmonary arteriovenous malformations are abnormal communications between the veins and arteries of thepulmonary circulation, leading to a right-to-left blood shunt.[5][6] They have no symptoms in up to 29% of all cases,[7] however they can give rise to serious complications includinghemorrhage, and infection.[5] They are most commonly associated withhereditary hemorrhagic telangiectasia.[6]
AVMs are usuallycongenital and are part of theRASopathy family of developmental syndromes.The understanding of the anomaly'sgenetic transmission patterns are incomplete, but there are known geneticmutations (for instance in theepithelial line, tumor suppressorPTEN gene) which can lead to an increased occurrence throughout the body.[citation needed]
In thecirculatory system, arteries carry blood away from the heart to thelungs and the rest of the body, where the blood normally passes throughcapillaries—where oxygen is released and waste products likecarbon dioxide (CO2) absorbed—before veins return blood to the heart.[9] An AVM interferes with this process by forming a direct connection of the arteries and veins, bypassing thecapillary bed.[10] AVMs can cause intense pain and lead to serious medical problems. Although AVMs are often associated with the brain and spinal cord, they can develop in other parts of the body.[10]
As an AVM lacks the dampening effect of capillaries on the blood flow, the AVM can get progressively larger over time as the amount of blood flowing through it increases, forcing the heart to work harder to keep up with the extra blood flow. It also causes the surrounding area to be deprived of the functions of the capillaries. The resulting tangle ofblood vessels, often called anidus (Latin for 'nest'), has no capillaries. It can be extremely fragile and prone to bleeding because of the abnormally direct connections between high-pressure arteries and low-pressure veins.[11] One indicator is a pulsing 'whoosh' sound caused by rapid blood flow through arteries and veins, which has been given the termbruit (French for 'noise'). If the AVM is severe, this may produce an audible symptom which can interfere with hearing and sleep as well as cause psychological distress.[1]
An arterial venous malformation of the left kidney and a simple cyst of the right kidneyAn arterial venous malformation of the left kidney leading toaneurysmal dilatation of the leftrenal vein andinferior vena cava
AVMs are diagnosed primarily by the followingimaging methods:[12]
Computed tomography (CT) scan is a noninvasive X-ray to view the anatomical structures within the brain to detect blood in or around the brain. A newer technology calledCT angiography involves the injection ofcontrast into the blood stream to view the arteries of the brain. This type of test provides the best pictures of blood vessels through angiography and soft tissues through CT.
Magnetic resonance imaging (MRI) scan is a noninvasive test, which uses a magnetic field and radio-frequency waves to give a detailed view of the soft tissues of the brain.
Magnetic resonance angiography (MRA) – scans created using magnetic resonance imaging to specifically image the blood vessels and structures of the brain. A magnetic resonance angiogram can be an invasive procedure, involving the introduction of contrast dyes (e.g.,gadolinium MRcontrast agents) into the vasculature (circulatory system) of a patient using acatheter inserted into an artery and passed through the blood vessels to the brain. Once the catheter is in place, the contrast dye is injected into the bloodstream and the MR images are taken. Additionally or alternatively, flow-dependent or other contrast-free magnetic resonance imaging techniques can be used to determine the location and other properties of the vasculature.
Treatment for AVMs in the brain can be symptomatic, and patients should be followed by a neurologist for any seizures, headaches, or focal neurologic deficits. AVM-specific treatment may also involveendovascular embolization, neurosurgery or radiosurgery.[1]Embolization, that is, cutting off the blood supply to the AVM with coils, particles, acrylates, or polymers introduced by a radiographically guided catheter, may be used in addition to neurosurgery or radiosurgery, but is rarely successful in isolation except in smaller AVMs.[24] Agamma knife may also be used.[25]
If a cerebral AVM is detected before a stroke occurs, usually the arteries feeding blood into the nidus can be closed off to avert the danger.[26] Interventional therapy may be relatively risky in the short term.[27]
Treatment of lung AVMs is typically performed with endovascular embolization alone, which is considered the standard of care.[15]
The estimated detection rate of AVM in the US general population is 1.4/100,000 per year.[28] This is approximately one-fifth to one-seventh the incidence ofintracranial aneurysms. An estimated 300,000 Americans have AVMs, of whom 12% (approximately 36,000) will exhibit symptoms of greatly varying severity.[1]
Hubert von Luschka (1820–1875) andRudolf Virchow (1821–1902) first described arteriovenous malformations in the mid-1800s.Herbert Olivecrona (1891–1980) performed the first surgical excision of an intracranial AVM in 1932.
ActorRicardo Montalbán was born with spinal AVM.[29] During the filming of the 1951 filmAcross the Wide Missouri, Montalbán was thrown from his horse, knocked unconscious, and trampled by another horse which aggravated his AVM and resulted in a painful back injury that never healed. The pain increased as he aged, and in 1993, Montalbán underwent9+1⁄2 hours of spinal surgery which left him paralyzed below the waist and using a wheelchair.[30]
Composer and lyricistWilliam Finn was diagnosed with AVM and underwent gamma knife surgery in September 1992, soon after he won the 1992Tony Award for best musical, awarded toFalsettos.[31] Finn wrote the 1998 Off-Broadway musicalA New Brain about the experience.
Actor/comedianT. J. Miller was diagnosed with AVM in 2010; Miller had a seizure and was unable to sleep for a period. He successfully underwent surgery that had a mortality rate of 10%.[33]
On August 3, 2011,Mike Patterson of thePhiladelphia Eagles collapsed on the field and had a seizure during a practice, leading to him being diagnosed with AVM.[34]
Former Florida Gators and Oakland Raiders linebackerNeiron Ball was diagnosed with AVM in 2011 while playing forFlorida, but recovered and was cleared to play. On September 16, 2018, Ball was placed in a medically induced coma due to complications of the disease, which lasted until his death on September 10, 2019.[35]
Indonesian actressEgidia Savitri [id] died from complications of AVM on November 29, 2013.[36]
Jazz guitaristPat Martino experienced an AVM and subsequently developedamnesia andmanic depression. He eventually re-learned to play the guitar by listening to his own recordings from before theaneurysm.[37]
Country music singerDrake White was diagnosed with AVM in January 2019, and is undergoing treatment.
Singer-songwriterDino Valenti (actual name Chester William Powers, Jr.) of the psychedelic rock bandQuicksilver Messenger underwent brain surgery for AVM in the late 1980s.
ModelLucy Markovic died in April 2025 at age 27 shortly after undergoing surgery to treat AVM.[39]
^abReichert, M; Kerber, S; Alkoudmani, I; Bodner, J (April 2016). "Management of a solitary pulmonary arteriovenous malformation by video-assisted thoracoscopic surgery and anatomic lingula resection: video and review".Surgical Endoscopy.30 (4):1667–9.doi:10.1007/s00464-015-4337-0.PMID26156615.S2CID22394114.
^abCusumano, Lucas R.; Duckwiler, Gary R.; Roberts, Dustin G.; McWilliams, Justin P. (August 30, 2019). "Treatment of Recurrent Pulmonary Arteriovenous Malformations: Comparison of Proximal Versus Distal Embolization Technique".CardioVascular and Interventional Radiology.43 (1):29–36.doi:10.1007/s00270-019-02328-0.ISSN1432-086X.PMID31471718.S2CID201675132.
^Barley, Fay L.; Kessel, David; Nicholson, Tony; Robertson, Iain (2006). "Selective Embolization of Large Symptomatic Iatrogenic Renal Transplant Arteriovenous Fistula".CardioVascular and Interventional Radiology.29 (6):1084–7.doi:10.1007/s00270-005-0265-z.PMID16794894.S2CID9335750.
^Kishi, K; Shirai, S; Sonomura, T; Sato, M (2005). "Selective conformal radiotherapy for arteriovenous malformation involving the spinal cord".The British Journal of Radiology.78 (927):252–4.doi:10.1259/bjr/50653404.PMID15730991.
^Bauer, Tilman; Britton, Peter; Lomas, David; Wight, Derek G.D.; Friend, Peter J.; Alexander, Graeme J.M. (1995). "Liver transplantation for hepatic arteriovenous malformation in hereditary haemorrhagic telangiectasia".Journal of Hepatology.22 (5):586–90.doi:10.1016/0168-8278(95)80455-2.PMID7650340.
^Rivera, Peter P.; Kole, Max K.; Pelz, David M.; Gulka, Irene B.; McKenzie, F. Neil; Lownie, Stephen P. (2006). "Congenital Intercostal Arteriovenous Malformation".American Journal of Roentgenology.187 (5): W503–6.doi:10.2214/AJR.05.0367.PMID17056881.
^Shields, Jerry A.; Streicher, Theodor F. E.; Spirkova, Jane H. J.; Stubna, Michal; Shields, Carol L. (2006). "Arteriovenous Malformation of the Iris in 14 Cases".Archives of Ophthalmology.124 (3):370–5.doi:10.1001/archopht.124.3.370.PMID16534057.
^Batur, Pelin; Stewart, William J.; Isaacson, J. Harry (2003). "Increased Prevalence of Aortic Stenosis in Patients With Arteriovenous Malformations of the Gastrointestinal Tract in Heyde Syndrome".Archives of Internal Medicine.163 (15):1821–4.doi:10.1001/archinte.163.15.1821.PMID12912718.
^Jafar, Jafar J.; Davis, Adam J.; Berenstein, Alejandro; Choi, In Sup; Kupersmith, Mark J. (January 1, 1993). "The effect of embolization with N-butyl cyanoacrylate prior to surgical resection of cerebral arteriovenous malformations".Journal of Neurosurgery.78 (1):60–69.doi:10.3171/jns.1993.78.1.0060.ISSN0022-3085.PMID8416244.
^Vida, Vendela.Confidence, or the Appearance of Confidence: The Best of the Believer Music Interviews. No ed. San Francisco, CA: Believer, a Tiny Division of McSweeney's Which Is Also Tiny, 2014. Print.
