Arteriovenous Malformation (AVM)

Arteriovenous malformations (AVMs) are abnormal tangles of blood vessels within the brain — specifically, they are abnormal arteries connected to abnormal veins. The abnormality is present from birth and found in 1 in 700 people (0.14% of the general population). Almost all AVMs are non-hereditary.

Why rely on Washington University experts to treat your arteriovenous malformation?

Washington University cerebrovascular surgeons, who specialize in endovascular treatment and open arteriovenous malformations (AVMs) resection, work as part of a multidisciplinary team to offer treatment for AVMs at the Barnes-Jewish Hospital Stroke and Cerebrovascular Center.

The Center is among the most experienced in managing brain vascular malformations and receives physician referrals from across the country. Along with cerebrovascular surgeons, other physician members of the treatment team include neurologists who specialize in interventional radiology, critical care and neuro-rehabilitation neurologists, and radiation oncologists, who perform Gamma Knife® Radiosurgery. They also offer:

• minimally invasive techniques to treat AVMs
• novel use of combined embolization and radiosurgery to treat complex, high-grade AVMs
• intraoperative angiography to confirm effectiveness of AVM treatment at time of procedure.

Arteriovenous Malformation Treatment

AVMs, which can cause hemorrhagic stroke, are treated on a case-by-case basis. The treatment selected depends on the location and size of the AVM, the severity and nature of symptoms, the patient’s age and health status, and the risk involved in treatment. 

Treatment options include:

• Observation
• Surgery
• Gamma Knife radiosurgery
• Endovascular embolization

Observation

This may be an appropriate approach for certain patients, including people who are older, have multiple medical problems or have complex AVMs for which treatment carries high risk.

Surgery

In this inpatient procedure, the AVM is removed from the brain through open surgery. If successful, it provides immediate protection against AVM rupture. Surgery is a good option for many AVM patients. If the AVM is complex or difficult to reach, however, this treatment may be a less attractive option. 

Gamma Knife Radiosurgery

This less-invasive form of treatment is a one-day outpatient procedure in which beams of radiation are precisely focused on the AVM, causing it to shrink over time. In most patients, the AVM will be cured in 1-3 years after treatment. Such radiosurgery is most useful for smaller AVMs, but can be used selectively for the treatment of larger AVMs.

Endovascular Embolization

A small catheter (tube) is used in this inpatient procedure. The catheter is passed from a blood vessel in the groin (or arm) up into the AVM, where glue or other material is injected. Endovascular embolization is primarily used in preparation for surgery or radiosurgery to make the treatments safer and more effective. In some cases, the treatment can cure the AVM, making surgery or radiosurgery unnecessary.