Management of arteriovenous malformations is dependent upon 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 asymptomatic lesions are sometimes observed over time without intervention.
Supportive care. All patients with lung AVMs require preventative antibiotics for dental procedures (including routine cleaning) and some surgical procedures such as scopes of the digestive and reproductive tracts. This usually involves taking a single larger dose of antibiotic by mouth one hour prior to the procedure.
Drug therapy. The biology of AVMs is being investigated so that medical options may be available for treatment. Some medications that have been used include doxycycline, thalidomide and its derivatives, bevacizumab and sirolimus.
Surgical excision (removal). This approach may be possible with localized lesions. When combined with preoperative embolization, excision offers the best chance for cure. If the core of the lesion is completely removed, the lesion may never recur. When the location and extent of the arteriovenous malformation make removal of the entire core of the lesion impossible, the lesion may recur.
Embolization. For more extensive lesions and/or when lesions are diffuse and surgery is not possible, embolization may improve overall quality of life by controlling the blood flow through the malformation and lessening symptoms for a period of time. 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.
Are there any risks associated with treatment?
The mentioned management approaches have certain benefits that improve the functioning and emotional well-being of the child. Despite these benefits, each management approach has drawbacks and limitations.
Drug therapy. As with any medication, these above medications have potential side effects. Prior to starting any medication, your provider will review the common, less common and rare side effects.
Surgical excision (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 known potential complication.
Embolization. Most patients do not have problems or serious side effects; however, bleeding or bruising can occur at the catheter site. Clotting of an artery or damage to normal tissue can also occur.