Results for Arteriovenous Malformations

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AVM stands for Arteriovenous Malformation. We believe that, in almost all cases, it developed during the development of the child in utero, and it basically involves two different kinds of blood vessels that should not be directly connected, actually being connected. In the body we have the arteries, which are the vessels that carry blood from the heart to the rest of the body. The arteries are thick walled and they're designed to carry high flow and high pressure blood. Once the blood gets to wherever it's going in the body, the arteries split again and again until ultimately they get to the capillaries which are the tiny microscopic vessels where the oxygen is given to all the tissues of the body. Once the oxygenation has taken place, it's the veins that takes the blood back to the heart from the brain, and the veins are very thin walled and they're designed to carry low pressure, slow flow blood back to the heart. So the arteries and the veins are quite different in how they're built, and they really should not have blood in direct communication. An AVM consists of an area, where for some reason during development, the arteries and the veins are directly connected by a very tiny network of very small vessels, where there's basically no pressure drop that's happening, so you have the high pressure blood going straight from the arteries into the vein, as a kind of short circuit. That pressure builds up to the point where there's a weak spot that eventually ruptures and causes a bleed. Thankfully, the initial bleed is often contained by the surrounding pressure within the skull. This allows a clot to form, which temporarily stops the flow of blood, stabilizing the patient. We still need to treat the AVM before that weak spot ruptures again, because every bleed in the brain is potentially a severe risk to the patient. If the AVM occurs at a very young age and is very high flow, it can cause other trouble, such as heart failure, for example, just because of the degree of flow through the AVM. Arteriovenous Malformations, as you heard Dr. Orbach say, is a tangle of blood vessels, that grew abnormally, and has a risk of bleeding, and so the goal of treating an AVM is to try to reduce that risk of bleeding, hopefully to make it go away altogether. There are basically four ways to treat an AVM. One way is surgery. You can just cut it out. And if you remove the AVM, the goal is by making it go away, hopefully you've taken away the risk of bleeding. A second way to treat an AVM is with radiation. It's kind of like getting a sunburn. If you treat an AVM with radiation, over a period of time, those blood vessels begin to thicken up, and they begin to close off the tubing that blood travels through, and the end result is that the AVM shrivels up, and hopefully over a period of time, months, years, that AVM disappears. The third way to treat it is with embolization, and the idea there is something that Dr. Orbach can do, for example, where you can thread a very tiny wire up through the blood vessels inside the body, you can squirt different types of agents to plug up the pipes from the inside, which can help to slow down or stop the flow of blood inside an AVM. The fourth way to treat it is to observe it. Sometimes, the safest thing to do, if the AVM is very big or if it is in a very sensitive part of the brain, is to just watch it, because it may be that the risk of treating the AVM might have more side effects and might be more dangerous than leaving the AVM alone. The great thing about, I think, what we have here at the Cerebrovascular Center, is that we have all of those treatments available here, we can provide them individually or in combination, and when decisions are made to treat an AVM, they're done with everybody at the table, and we try to put together the best plan possible for treating the child with their AVM.

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An arteriovenous malformation or an AVM is an abnormal formation of blood vessels connecting arteries and veins, bypassing the capillary system. The blood vessels of an AVM are commonly dilated and weakened due to high blood pressure and an AMV may bleed. Bleeding from an AVM may cause damage to surrounding brain tissue and result in a hemorrhagic stroke. An AVM can develop anywhere in the body but occurs most often in the brain or spine. AVMs are mostly congenital but not hereditary. They are believed to form during embryonic or fetal development. AVM embolization is an endovascular treatment aimed to block blood flow in to an AVM and therefore reduce the risks of AVM bleeding. In this procedure, a catheter is inserted through the femoral artery at the groin and threaded all the way to the brain AVM. The catheter is used to inject a special glue into the AVM. The glue hardens when it comes into contact with the blood and seals off the AVM from the blood flow. AVM blood vessels do not supply normal brain tissue and therefore their blockage will not have any consequences on the patient. AVM embolization is rarely successful on its own. It is useful, however, in conjunction with other procedures such as surgery or radiation. Performing AVM embolization PRIOR to surgical removal helps to reduce significantly the risk of AVM bleeding during surgery.

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(soft music) >> My garage, that's my second home you know. I don't actually live here so I live in the garage. But working on my car, it helps me and that's my passion. Working on my little '79 Trans Am. Maybe that played a part in my recovery, I really think it did. About a year ago I started having headaches. They were pretty bad headaches and I knew something else was wrong. >> We decided to look for a neurologist here in Virginia. They decided to do another MRI and which they did and it actually showed the AVM, and he shared with us that it was some aneurysms there as well because of the AVM. >> A brain Arteriovenous Malformation or an AVM for short is an abnormal tangle of blood vessels in the brain. There are various grading classifications for these that really predict how severe they can be or particularly how complicated the surgery can be to remove these. In William's case, he had the highest grade which was a grade five AVM. >> I decided to let's go online and start looking at different doctors, different hospitals. We together did some research. Typed in "top 10 hospitals for brain surgery" and Hopkins was number one. >> An AVM as complicated as William's really has many aspects that we need to deal with when thinking about how to treat this. There's the AVM itself but also, there can be other components of the AVM that make it higher risk such as an aneurysm. Before we ever take a patient to surgery we really want to make sure that surgery is as safe as it possibly can be. So in William's case we brought him in several times to preform what's called an Embolization where we can close down blood supply to both the AVM as well as to aneurysms associated with an AVM and this is all done in a minimally invasive way. It's all done through the blood vessels. We access the blood vessel in the leg and then we're able to get all the way up to the brain and take care of something like this. And a procedure that's typically very well tolerated and often the patient goes home the next day or the day after. >> The first procedure started in July and the last one was in December. The major surgery was in January 12th. >> So in January William had a surgical procedure called a Craniotomy which means that we made an opening in the skull to be able to get to the brain and to remove the AVM. These procedures are long tedious surgeries where we decrease the blood supply to the Arteriovenous Malformation and that enables us to then resect the entire thing really providing him a cure. >> Rosalyn: He told us what to expect once the surgery was completed. That he might not remember some things right away. That part of the brain might affect that he couldn't talk You know, might be to the point that he couldn't think how to walk. >> The surgery was successful. >> He hasn't had a-- >> William: Not one headache since. >> Not one headache and actually, knew who everybody was right away. The swelling went down just it's supposed to, it wasn't a long delay on that. His... >> Hair grew back. >> Rosalyn: Yeah it grew back quickly. >> William: For the most part. >> Fortunately William did very well. Despite having the highest grade AVM, or a grade five AVM, which really would put him at risk for having significant complications from the surgery, he did great. He spent a few days in the hospital and then went home and was able to return to his normal life. >> Hopkins did so much support and experience and certainly fun to be able to get back to my car and continue to enjoy as I have before the surgery. My yard, I love my yard. Can't forget my wife, she's been great through all of this. She's really been great. To talk about support I don't think I could have went through this without this woman right here, she's really been awesome and she continues right today to support me 100%. To have her with me has really been good. (gentle music)