AVM

Arteriovenous malformation
 Definition
Is an abnormal connection between arteries and
veins.
 Are complex connection between the arteries
and vein that lack intervening capillary bed .
 The arteries have a deficient muscularies
layer ,the draining vains often are dilated .
Epidemiology and pathophysiology

 no sexual preference .
 Mean age presentation 30 to 40 years

 Account 3% stroke , and 33% primary intra

cerebral hge in young adult .
 Pathophysiology
 Can develop aneurysm and rupture, creating a cerebral
hemorrhage .
 Can cause hydrocephalus and seizures .

 Develop during fetal development .

 Sign and symptoms

 Asymptomatic unless hemorrhage .

 Headache .

 seizure and increase ICP .

 Progressive weakness and numbness .

 When bleeding into the brain occurs , sign and
symptoms can be similar to a stroke and may include :

 Sudden severe headache .

 Weakness , numbness or paralysis

 Vision loss

 Difficulty speaking .
 Diagnostic test
 Cerebral
arteriography .
 Computerized tomography ( CT ).

 CTA .

 MRI .
 Treatment

 Surgical removal .
 Endovascular embolization .

 Stereotastic radiosurgery .
  Nursing care

 If there is small and unruptured the nursing focus is on

preventing an increase in blood pressure and preparing
the patient for the procedure .
 In severe cases the patient will be admitted immediately
to wait for surgical .
 Maintain absolute bed rest to keep blood pressure .
 patient should avoid sneezing or coughing if possible.

 Teach avoidance of the valsalva maneuver during

avoiding or defecating .
 Patient environment should be as non stimulation .
Avoid rising the patients blood
pressure any way
 Sedation and analgesics may be given to prevent
anxiety , pain and to keep the activity to a minimum .
 Antihypertensive may be given to control blood pressure
.
 Monitor vital signs and neurological status frequently .

 Report any deterioration of condition immediately to the

physician .
 Obtain pre and post_and operative lab result and notify
the physician of any abnormal .
 Provide honest reassurance to decrease anxiety .

 Post operative in icu you must monitor wounds for signs

of bleeding .
 Intracranial monitoring may be placed post operative .

 The patient and family will need to learn self care , and
sign and symptoms of complications.
 Complication

 Bleeding in the brain .

 Reduce oxygen to brain tissue .

 Weak blood vessels

 Brain damage .
 Summery
 AVMs are complicated vascular malformations which
can grow in the brain, head and neck area, limbs, or even
in organs.
 An understanding of the functional vascular anatomy is
critical to successful treatment.
 Successful treatment requires a multi-disciplinary team
that has constant interaction.
 The combination of pre-surgery embolization followed
by surgical resection is currently yielding the most
successful results for head, neck and body lesions.
 A combination of surgery, embolization and/or radiation
has the highest success rate for treating brain AVMs.
 Each AVM is unique and complicated. A treatment
algorithm can be followed to achieve optimal results