AV Malformation
Arteriovenous malformation
Arteriovenous malformation (AVM) is high flow vascular malformation.
Arteriovenous Malformation (AVM) is high flow vascular malformation. It is an abnormal tanglement of blood vessels connecting arteries and veins which disrupts normal blood flow and oxygen circulation. It is basically an abnormal connection between the arteries and veins, which bypasses the capillary system. It is widely known because of its occurrence in the brain.
Arteries are responsible for taking oxygen rich blood from the heart to the body and veins carry the oxygen depleted blood from body to lungs and heart. This process is disrupted by the arteriovenous malformation and the surrounding tissues may not get enough oxygen.
Generally, most AVM are asymptomatic and are diagnosed as "Incidental Finding" and the only presentation could be of swelling of the region with little heaviness. There are some which cause bleeding, intense pain or other severe medical conditions. The symptoms of AVM usually vary with the site of the mal formation. Usually, a micro bleed from AVM or its expansion causes pain, neurological deficit or sudden enlargement.
There are specific symptoms of AVM which depend on the locations of the malformation which include:
- Difficulties in everyday activities
- There might be abnormal sensations like tingling, numbness or random pain.
- Some AVM also include difficulty with movement coordination which includes sometimes paralysis or muscle weakness
AVM may occur in different parts of the body. They are like arm, shoulder, face, thigh, leg etc.
The treatment of AVMS can be symptomatic. Patients should visit a Neurologist for any seizures or headaches or neurological deficits. The treatment plan for AVMs depends on the site and onset of symptoms.
Diagnosis
- Clinical examination
- Swelling with soft consistency
- Bluish color
- Increase in size in dependent position
- Bruits on auscultation (machinery murmur)
- MRI scan is routinely done to know the anatomical extent of lesion in all the planes.
Surgical Treatment
Wide local excision is the surgery of choice in AVM with preservation of surrounding vital structures.
The surgical procedure for high flow arteriovenous malformation is highly challenging and technically demanding. The procedure requires a lot of preparation from both the patient and the doctor side.
A thorough knowledge of the vessel feeders and the anatomy, distribution of vessels and extent of the malformation should be known to the surgeon.
Possible complications, requirement of more than one stage in excision and method of coverage of created defect after the excision of malformation should be agreed upon by the patient and his or her attendants.
Sometimes in few cases, if the extent of the malformation is too extensive and deep and if the excision requires sacrifice of major vessel or nervesor endangers the survival of the part, then complete excision is not done and part of the malformation which is near to the vital structures is left behind sothat the function of the part is disturbed less.
The remaining part can be excised in separate stageafter few months.
May require post-surgical reconstruction with flap/skin graft cover
- Skin grafting may be done if defect is not much deep and vitals structures are embedded deep and not exposed.
- Local Flap Reconstruction Local flap is the transfer of flap of skin from the surrounding areas to the defect site. It is done when defect is deep and surrounding area is normal and sufficient enough to cover the defect
- Microvascular Free Flaps which is usually done when any critical part is exposed like bones, tendons, joints and it becomes really important to preserve them for the normal functioning. A well blood supplied tissue is taken from the adjacent area or from other areas of the body to cover the part of the limb with it. The flap should be monitored frequently post-surgery. Hospital stay is increased, with respect to skin grafting or local flap procedures, but it is the best modality to cover the defects in AVM patients. Dressing is done every alternate day and patient is admitted for at least 7-8 days and discharged once the flap is settled.
Recurrence rate is high in high flow large AVMsas most of the times complete excision is not possible and debulking is done to lessen the symptoms of the AVM on the body show.
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Best plastic surgeon, Dr. Amit Agarwal is an American Board Certified, extensively trained, and best Plastic & Aesthetic surgeon in Lucknow. He is the Chief Plastic Surgeon heading the Department of Plastic, Microvascular, and Craniofacial surgery at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, U.P, India. He maintains a busy practice at Avadh and Nishat Hospital and his own center - Kayakriti Plastic Surgery & Dental Center. He was formerly a Consultant in the Department of Plastic Surgery and Burns at the prestigious SGPGI, Lucknow.
MS, DNB (General Surgery) MCh, DNB (Plastic Surgery),
MNAMS, FACS, FICS, FRCS (Edinburgh, UK)
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Frequently Asked Questions
If you have flat or small breast and you want to improve your breast and hip contour ratio then you are a good candidate for it. The answer will be best provided after the first consultation with Dr Amit Agarwal.
Acute pain will be there for almost a week which gradually reduces and there will be soreness and swelling which may take up to 3 weeks to subside.
You can join your work and daily routines after a week of the procedure and can start exercising after 3 weeks of it.
Yes, you have to wear it round the clock unless we suggest you to remove it.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
Kayakriti Plastic Surgery & Dental Center
D-43, Near Punjab National Bank, Rajajipuram, Lucknow, Uttar Pradesh - 226017, India
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