Should my child receive treatment?
Individuals with AVMs or suspected AVMs should visit an AVM specialist. Treatment decisions must be made on an individual basis.
How are AVMs managed?
Management of AVMs depend on individual symptoms and potential complications. Both non-operative and surgical approaches are used. AVMs generally require evaluation and treatment by a multidisciplinary team of experts. Regular follow up is important to monitor and manage complications.
Observation. Small lesions without symptoms are observed over time.
Supportive care. All patients with lung AVMs require preventative antibiotics for dental procedures (including routine cleaning). Some surgical procedures such as scopes of the digestive and reproductive tracts need antibiotics as well. This involves taking a single larger dose of antibiotic by mouth 1 hour prior to the procedure.
Drug therapy. Some medications that have been used include doxycycline, thalidomide and its derivatives, bevacizumab, and sirolimus.
Surgical excision (removal). This approach may be possible with certain lesions. When combined with preoperative embolization, removal offers the best chance for cure. If the core of the lesion is completely removed, the lesion may never return. If complete removal of the core is not possible, the lesion may return or cause similar or different issues.
Embolization. Embolization is an injection of material into the center of the lesion to block the blood supply to the lesion. There are several different materials that interventional radiologists can use for embolization. This is often used with the lesions are larger and surgery is not an option.
Are there any risks associated with treatment?
Treatment is aimed to prevent future issues and improve the functioning and emotional wellbeing of the individual. Despite these benefits, each treatment approach has drawbacks and limitations.
Drug therapy. As with any medication, these medications have potential side effects. Prior to starting any medication, your provider will review side effects.
Surgical removal. Some degree of scarring will occur with surgery. Surgical interventions may also cause damage to structures involving or near the malformation. Bleeding during surgery is a potential complication.
Embolization. Most patients do not have problems or serious side effects. Bleeding or bruising can occur at the catheter site. Clotting of an artery or damage to normal tissue is also possible.