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Treatment of Arterio-venous malformations

At the outset, it must be stated that we can treat arterio-venous malformations very well and in the vast majority of cases, we can improve the quality of life of the patient significantly. Treatment will usually consist of embolization, with or without surgery. There are some instances where we embolize only and there are some instances where we use surgery as our sole means of treatment. Decisions are usually made by our multidisciplinary team. Embolization is a procedure whereby, through an artery, a catheter is advanced until it reaches the site of the disease. At this point, a substance or particles are placed within the nidus of the AVM until the degree of shunting is reduced or it has been eliminated. Using percutaneous (across skin) access, substances can also be used to block the venous system of the AVM. This is usually followed within 24 – 48 hours by surgical resection of the nidus. There is a dilemma. If the AVM is extensive, it is important to resect only enough tissue to prevent a recurrence if this is possible.

Resecting too much tissue, especially in the head and neck region will be too disfiguring. It is therefore important to avoid this and err on the side of being conservative. In extensive cases, a larger resection with soft tissue reconstruction is necessary.