Arteriovenous malformations (AVMs) are usually congenital abnormalities of the blood vessels in which there is an abnormal connection between arteries and veins. They can be found in any part of the body. Small AVMs, maybe totally asymptomatic and only accidentally discovered. Cutaneous lesions present as a lamp, pink stain, dilated veins or even skin ulceration. Approximately 50% of the patients will experience pain.  Highly vascular could be fragile and bleed.

Duplex ultrasound and MRI are the investigations needed to detect and characterise the type of the vascular malformation. It is of paramount importance to differentiate a vascular malformation from a rare  vascular tumour.

Small AVMs are often monitored with no intervention as the majority will not cause long term problems. Larger AVMs or those causing symptoms require treatment which could be either endovascular or surgical.

Management of AVMs is complex and often require multiple treatments.

Surgery involves identifying and stopping the arterial supply of the malformation before excising the whole AVM intact. Reconstructive plastic surgery is often required at the same time to provide an acceptable cosmetic result if a large excision has been performed.

Minimally invasive endovascular procedures involve thrombosis and destruction of the nidus of the AVM with the injection of glue or absolute ethanol. Slow flow AVMs are usually directly injected with sclerosants (fibrovein) or absolute ethanol.

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Arteriovenous Malformations