Arteriovenous Malformation

WHAT YOU SHOULD KNOW:

An arteriovenous malformation (AVM) is an abnormal connection between arteries and veins. Blood flows too quickly from the arteries and pushes on the walls of the veins. This can damage or weaken the veins and cause them to bulge and get twisted. If they burst, blood will leak into surrounding tissue, and may cause a stroke. People who have AVMs are usually born with this condition. The exact cause is not known.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Treatment may not remove the AVM. You may get another AVM, even after treatment. You may get an infection after surgery or bleed more than expected during surgery. You may develop brain damage. AVM treatment during pregnancy puts both the mother and the unborn baby at risk. The increased blood pressure that occurs with pushing the baby out during delivery can affect the AVM.
  
  
• Left untreated, your AVM may get bigger or more tangled, and have a greater chance of bursting. You are at risk of a stroke if the AVM bursts. Blood may build up and block other blood vessels. The areas not getting enough blood can be damaged or even die. Blood that stays in the brain too long may cause brain swelling. The swelling can cause long-term problems, such as trouble talking, thinking, or moving your arms and legs.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Food and liquids:

You may get nutrition and liquids through an IV. If your swallowing problems are severe, you may need a nasogastric (NG) tube. An NG tube is put into your nose and goes down to your stomach. As your swallowing improves, you will first be given thickened liquids. You may also be able to eat soft foods. When your swallowing is better, you may be able to start eating normally again.

Medicines:

• Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.
  
  
• Blood pressure medicine: This medicine lowers your blood pressure to protect your blood vessels from rupturing and bleeding.
  
  
• Diuretics: You may get diuretic medicine to help decrease swelling in your brain. This may help your brain get better blood flow.
  
  
• Steroid medicine: This medicine may be given to decrease swelling in your brain. Do not stop taking this medicine without your caregiver's OK.
  
  
• Stool softeners: You can cause an AVM if you strain to have a bowel movement. This medicine will make your bowel movements softer so you do not have to strain.

Neurologic exam:

This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.

Oxygen:

You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

Tests:

Dye may be put into your vein to help the blood vessels show up better. Tell your caregiver if you are allergic to shellfish or iodine. You may also be allergic to the dye. You may have any of the following:

• Blood and urine tests: Blood and urine samples may be taken for different tests.
  
  
• Angiogram: This test is used to check for problems with blood flow in your brain. X-rays are taken as the dye goes into blood vessels in your brain.
  
  
• CT scan: This is also called a CAT scan. An x-ray machine uses a computer to take pictures of your brain. It may be used to look at bones, muscles, brain tissue, and blood vessels.
  
  
• MRI: This scan uses powerful magnets and a computer to take pictures. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell caregivers if you have any metal implants.

Treatments:

• Brain surgery: The AVM is repaired or removed. You may also need surgery to repair any burst blood vessels or remove spilled blood in your brain.
  
  
• Embolization: This procedure may be done as the only treatment for your AVM. Sometimes it is done before surgery or radiation to make the AVM smaller and easier to treat. A catheter (tube) is put in a large blood vessel in your groin, and guided up to the AVM in your brain. Dye and an x-ray machine may be used to locate the AVM. Caregivers use the catheter to put chemicals, metal coils, or plastic beads in the AVM to stop the blood flow to it.
  
  
• Radiation therapy: This is also called radiosurgery. It uses x-ray machines, such as a gamma knife, to treat the AVM. You may have to go back several times to complete this therapy. Ask your caregiver for more information about radiation therapy.
  
  
• Stroke treatment: An AVM that bursts may cause you to have a stroke. Ask your caregiver for more information about stroke treatment.

Therapy:

A physical therapist and an occupational therapist may exercise your arms, legs, and hands. They may also teach you new ways to do things around the house. A speech therapist may work with you to help you talk or swallow.

Ventilator:

This is a machine that gives you oxygen and breathes for you when you cannot breathe well on your own. An endotracheal (ET) tube is put into your airway through your mouth or nose. You may need a trach if an ET tube cannot be placed. A trach is an airway tube put into an incision (cut) in the front of your neck. The ET tube or trach is attached to the ventilator.

Learn more about Arteriovenous Malformation (Inpatient Care)