Skip to main content
SpringerLink
Log in

Arteriovenous Malformation (AVM)

  • Chapter
  • First Online:
Essential Interventional Radiology Review

  • 1373 Accesses

Abstract

The International Society for the Study of Vascular Anomalies (ISSVA) has developed a classification system for vascular malformations based on histopathological and genetic understanding of these lesions. Arteriovenous malformations (AVMs) are classified as high-flow lesions. AVMs may be asymptomatic or result in pain, ischemia, or high-output cardiac failure. AVMs may occur sporadically or in association with Osler-Weber-Rendu syndrome, also known as hereditary hemorrhagic telangiectasia (HHT). Patients with HHT commonly present with epistaxis. On imaging, these lesions consist of a feeding artery, draining vein, and a tangle of vessels in between, also referred to as the “nidus.” Treatment for symptomatic patients may be performed in a staged fashion over multiple sessions. There is no ideal embolic agent to treat all AVMs, and approach must take into consideration the location of AVM, as well as the specific properties of the embolic material available.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Further Reading

  • Al-Shahi R, Warlow C. A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults. Brain. 2001;124(Pt 10):1900–26.

    Article  CAS  Google Scholar 

  • Arnold R, Chaudry G. Diagnostic imaging of vascular anomalies. Clin Plast Surg. 2011;38(1):21–9.

    Article  Google Scholar 

  • Bertino F, Braithwaite KA, Hawkins CM, Gill AE, Briones MA, Swerdlin R, Milla SS. Congenital limb overgrowth syndromes associated with vascular anomalies. Radiographics. 2019;39(2):491–515.

    Article  Google Scholar 

  • Blatt J, McLean TW, Castellino SM, Burkhart CN. A review of contemporary options for medical management of hemangiomas, other vascular tumors, and vascular malformations. Pharmacol Ther. 2013;139(3):327–33.

    Article  CAS  Google Scholar 

  • Burrows PE. Vascular malformations involving the female pelvis. Semin Interv Radiol. 2008;25(4):347–60.

    Article  Google Scholar 

  • Cartin-Ceba R, Swanson KL, Krowka MJ. Pulmonary arteriovenous malformations. Chest. 2013;144(3):1033–44.

    Article  Google Scholar 

  • Cho SK, Do YS, Kim DI, Kim YW, Shin SW, Park KB, Ko JS, Lee AR, Choo SW, Choo IW. Peripheral arteriovenous malformations with a dominant outflow vein: results of ethanol embolization. Korean J Radiol. 2008;9(3):258–67.

    Article  Google Scholar 

  • Cho SK, Do YS, Shin SW, Kim D, Kim YW, Park KB, Kim EJ, Ahn HJ, Choo SW, Choo IW. Arteriovenous malformations of the body and extremities: analysis of therapeutic outcomes and approaches according to a modified angiographic classification. J Endovasc Ther. 2006;13(4):527–38.

    Article  Google Scholar 

  • Contegiacomo A, Del Ciello A, Rella R, Attempati N, Coppolino D, Larici AR, Di Stasi C, Marano G, Manfredi R. Pulmonary arteriovenous malformations: what the interventional radiologist needs to know. Radiol Med. 2019;124(10):973–88.

    Article  Google Scholar 

  • Do YS, Yakes WF, Shin SW, Lee BB, Kim DI, Liu WC, Shin BS, Kim DK, Choo SW, Choo IW. Ethanol embolization of arteriovenous malformations: interim results. Radiology. 2005;235(2):674–82.

    Article  Google Scholar 

  • Dunham GM, Ingraham CR, Maki JH, Vaidya SS. Finding the nidus: detection and workup of non-central nervous system arteriovenous malformations. Radiographics. 2016;36(3):891–903.

    Article  Google Scholar 

  • Edmondson AC, Kalish JM. Overgrowth syndromes. J Pediatr Genet. 2015;4(3):136–43.

    Article  Google Scholar 

  • Evans RW. Diagnostic testing for the evaluation of headaches. Neurol Clin. 1996;14(1):1–26.

    Article  CAS  Google Scholar 

  • Faughnan ME, Palda VA, Garcia-Tsao G, Geisthoff UW, McDonald J, Proctor DD, Spears J, Brown DH, Buscarini E, Chesnutt MS, Cottin V, Ganguly A, Gossage JR, Guttmacher AE, Hyland RH, Kennedy SJ, Korzenik J, Mager JJ, Ozanne AP, Piccirillo JF, Picus D, Plauchu H, Porteous ME, Pyeritz RE, Ross DA, Sabba C, Swanson K, Terry P, Wallace MC, Westermann CJ, White RI, Young LH, Zarrabeitia R. HHT Foundation International - Guidelines Working Group. International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet. 2011;48(2):73–87.

    Article  Google Scholar 

  • Gershon AS, Faughnan ME, Chon KS, Pugash RA, Clark JA, Bohan MJ, Henderson KJ, Hyland RH, White RI Jr. Transcatheter embolotherapy of maternal pulmonary arteriovenous malformations during pregnancy. Chest. 2001;119(2):470–7.

    Article  CAS  Google Scholar 

  • Gilbert P, Dubois J, Giroux MF, Soulez G. New treatment approaches to arteriovenous malformations. Semin Interv Radiol. 2017;34(3):258–71.

    Article  Google Scholar 

  • Guimaraes M, Wooster M. Onyx (ethylene-vinyl alcohol copolymer) in peripheral applications. Semin Interv Radiol. 2011;28(3):350–6.

    Article  Google Scholar 

  • Guttmacher AE, Marchuck D, Trerotola SO, Pyeritz RE. Hereditary hemorrhagic telangiectasia, Chap 49. In: Rimoin DL, Pyeritz RE, Korf BR, editors. Emery and Rimoin’s principles and practice of medical genetics. 6th ed. Academic Press; 2013.

    Google Scholar 

  • Hasan M, Rahman M, Hoque S, Zahid Hossain AK, Khondker L. Propranolol for hemangiomas. Pediatr Surg Int. 2013;29(3):257–62.

    Article  Google Scholar 

  • Hyodoh H, Hori M, Akiba H, Tamakawa M, Hyodoh K, Hareyama M. Peripheral vascular malformations: imaging, treatment approaches, and therapeutic issues. Radiographics. 2005;25(Suppl 1):S159–71.

    Article  Google Scholar 

  • International Society for the Study of Vascular Anomalies. 2018 ISSVA classification of vascular anomalies. www.issva.org/classification. Accessed 1 Oct 2018.

  • Kandarpa K, Machan L, Durham J. Handbook of interventional radiologic procedures. Fifth ed. Philadelphia: Wolters Kluwer; 2016.

    Google Scholar 

  • Keefe NA, Haskal ZJ, Park AW. IR playbook: a comprehensive introduction to interventional radiology. 1st ed. Springer.

    Google Scholar 

  • Knopman J, Stieg PE. Management of unruptured brain arteriovenous malformations. Lancet. 2014;383(9917):581–3.

    Article  Google Scholar 

  • Kwon JH, Kim GS. Obstetric iatrogenic arterial injuries of the uterus: diagnosis with US and treatment with transcatheter arterial embolization. Radiographics. 2002;22(1):35–46.

    Article  Google Scholar 

  • Lacombe P, Lacout A, Marcy PY, Binsse S, Sellier J, Bensalah M, Chinet T, Bourgault-Villada I, Blivet S, Roume J, Lesur G, Blondel JH, Fagnou C, Ozanne A, Chagnon S, El Hajjam M. Diagnosis and treatment of pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: an overview. Diagn Interv Imaging. 2013;94(9):835–48.

    Article  CAS  Google Scholar 

  • Legiehn GM, Heran MK. A step-by-step practical approach to imaging diagnosis and interventional radiologic therapy in vascular malformations. Semin Interv Radiol. 2010;27(2):209–31.

    Article  Google Scholar 

  • Lowe LH, Marchant TC, Rivard DC, Scherbel AJ. Vascular malformations: classification and terminology the radiologist needs to know. Semin Roentgenol. 2012;47(2):106–17.

    Article  Google Scholar 

  • Marchuk DA, Guttmacher AE, Penner JA, Ganguly P. Report on the workshop on Hereditary Hemorrhagic Telangiectasia, July 10-11, 1997. Am J Med Genet. 1998;76:269–73.

    Article  CAS  Google Scholar 

  • Mohr JP, Parides MK, Stapf C, Moquete E, Moy CS, Overbey JR, Al-Shahi Salman R, Vicaut E, Young WL, Houdart E, Cordonnier C, Stefani MA, Hartmann A, von Kummer R, Biondi A, Berkefeld J, Klijn CJ, Harkness K, Libman R, Barreau X. Moskowitz AJ; international ARUBA investigators. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014;383(9917):614–21.

    Article  CAS  Google Scholar 

  • Monroe EJ. Brief description of ISSVA classification for radiologists. Tech Vasc Interv Radiol. 2019;22(4):100628.

    Article  Google Scholar 

  • Oduber CE, Young-Afat DA, van der Wal AC, van Steensel MA, Hennekam RC, van der Horst CM. The persistent embryonic vein in Klippel-Trenaunay syndrome. Vasc Med. 2013;18(4):185–91.

    Article  Google Scholar 

  • Pollak JS, White RI Jr. Distal cross-sectional occlusion is the “key” to treating pulmonary arteriovenous malformations. J Vasc Interv Radiol. 2012;23(12):1578–80.

    Article  Google Scholar 

  • Ratnani R, Sutphin PD, Koshti V, Park H, Chamarthy M, Battaile J, Kalva SP. Retrospective comparison of pulmonary arteriovenous malformation embolization with the polytetrafluoroethylene-covered nitinol microvascular plug, AMPLATZER plug, and coils in patients with hereditary hemorrhagic telangiectasia. J Vasc Interv Radiol. 2019;30(7):1089–97.

    Article  Google Scholar 

  • Rosen RJ, Contractor S. The use of cyanoacrylate adhesives in the management of congenital vascular malformations. Semin Interv Radiol. 2004;21(1):59–66.

    Article  Google Scholar 

  • Sánchez-Morales GE, Anaya-Ayala JE, Serrano-Cueva MA, Salas-Torrez E, Hinojosa CA. Hand ischemia due to steal syndrome associated with multiple arteriovenous malformations in a patient with Parkes-Weber syndrome. J Hand Surg Asian Pac Vol. 2019;24(1):89–92.

    Article  Google Scholar 

  • Shovlin CL. Pulmonary arteriovenous malformations. Am J Respir Crit Care Med. 2014;190(11):1217–28.

    Article  Google Scholar 

  • Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986;65(4):476–83.

    CAS  Google Scholar 

  • Trerotola SO, Pyeritz RE. PAVM embolization: an update. AJR Am J Roentgenol. 2010;195(4):837–45.

    Article  Google Scholar 

  • White RI Jr, Pollak JS, Wirth JA. Pulmonary arteriovenous malformations: diagnosis and transcatheter embolotherapy. J Vasc Interv Radiol. 1996;7(6):787–804.

    Article  Google Scholar 

  • Yakes WF. Endovascular Management of High-Flow Arteriovenous Malformations. Semin Interv Radiol. 2004;21(1):49–58.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mount Sinai Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Charles Hua

Authors
  1. Charles Hua
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles Hua .

Editor information

Editors and Affiliations

  1. The Hospital for Sick Children, Toronto, Ontario, ON, Canada

    Rajat Chand

  2. Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Adam E. M. Eltorai

  3. Brown University, East Providence, RI, USA

    Terrance Healey

  4. Brown University, Providence, RI, USA

    Sun Ahn

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hua, C. (2022). Arteriovenous Malformation (AVM). In: Chand, R., Eltorai, A.E.M., Healey, T., Ahn, S. (eds) Essential Interventional Radiology Review. Springer, Cham. https://doi.org/10.1007/978-3-030-84172-0_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-84172-0_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-84171-3

  • Online ISBN: 978-3-030-84172-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation