Chapter: Arteriovenous malformations
Article: 4 of 13
Update: June 02, 2021
Author(s): Uller, Wibke
Arteriovenous malformations (AVM) are always congenital, but they can be completely asymptomatic in early childhood and therefore remain undiagnosed. The symptoms caused by arteriovenous malformations during the course of the disease can primarily be explained by the progressive specific hemodynamics of this type of malformation with direct pathological connections between the arterial and venous system, bypassing the capillary bed. In the early stages of the disease, an asymptomatic or very mild course is possible.
The first symptoms are usually the development of swelling and a mild local warmth with reddish discoloration of the overlying skin compared to the surrounding tissue.
As the disease progresses, patients usually complain of pain in the area of the swelling.
Owing to the presence of shunts, this swelling may be associated with pulsation and increasing, spreading warmth. As a result of the increased volume and pressure load in the venous system, symptoms of chronic venous insufficiency may ensue. Both venous insufficiency and reduced arterial blood flow peripheral to the nidus can lead to a diffuse spread of pain. Compression or invasion of the surrounding tissue, caused by shunts and dilated vessels, can additionally cause functional and movement restrictions (e.g., muscle contractures, joint or bone involvement).
Depending on the angioarchitecture and localization, bleeding, ulcers and gangrenous changes may occur. Cardiac symptoms appear either directly after birth or only in the very advanced stages of the disease (tachyarrhythmia, left ventricular hypertrophy and dilatation, high-output cardiac failure).