Arteriovenous malformations (AVMs) happen when a group of blood vessels in your body forms incorrectly. 在这些畸形中, 动脉和静脉不寻常地纠缠在一起，形成直接连接, 绕过正常组织. 这通常发生在出生前或出后不久的发育过程中.

大多数动静脉畸形患者没有最初的症状或问题. Instead, the problem is discovered when health care providers treat another unrelated health concern. Sometimes the rupture of one of the blood vessels in an AVM will bring the issue to medical attention. 有时动静脉畸形是在死后尸检时发现的.

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©Eleanor Bailey

关于avm的事实

大多数动静脉畸形患者不会有任何问题. If symptoms have not appeared by the time a person is 50, they may never appear. Women sometimes have symptoms as a result of the burden that pregnancy places on the blood vessels. 然而，近12%的动静脉畸形患者确实有一些症状.

没有人知道为什么会形成avm. 一些专家认为，患动静脉畸形的风险可能是遗传的. 动静脉畸形可以在身体的任何部位形成. 形成于大脑或靠近脊髓的, 称为神经性动静脉畸形, 最有可能产生长期影响吗.

The biggest concern related to AVMs is that they will cause uncontrolled bleeding, or hemorrhage. Fewer than 4 percent of AVMs hemorrhage, but those that do can have severe, even fatal, effects. Death as a direct result of an AVM happens in about 1 percent of people with AVMs.

Sometimes AVMs can reduce the amount of oxygen getting to the brain and spinal cord (this is sometimes called a "steal" effect, 就好像血液从它应该流动的地方被“偷走”了一样). 动静脉畸形有时会对周围组织造成压力. Steal can also occur elsewhere in the body, such as in the hands or feet, but may not be as apparent.

An AVM occurs when arteries and veins aren't formed correctly in an area of the body. 正常情况下，动脉将血液从心脏输送到身体. Blood with fresh oxygen and nutrients is brought through the arteries into very tiny vessels called capillaries. 血液通过这些细小的血管进入身体的组织. 然后血液通过毛细血管离开组织，流入静脉, 让血液回到心脏. 毛细血管是帮助血液流速减慢的小血管. 这使得血液能够将氧气和营养物质输送到组织中.

在AVM中, 没有毛细血管, 所以血液不会减慢, 它也不能向身体组织输送氧气和营养物质. Instead, blood that is flowing very fast (high flow) goes directly from an artery to a vein. 很少, 如果有很多血流通过动静脉畸形, 它会导致心脏工作太辛苦而跟不上节奏, 导致心力衰竭.

虽然出生时就存在, AVM可能在出生后不久就被发现，也可能在生命的后期被发现, 取决于它的大小和位置. AVMs can become apparent after an accident or as a child grows into an adult (during puberty). 随着推荐十大正规网赌平台身体的成长，AVM也在成长.

avm会随着时间的推移而增长和变化. avm通常使用称为Schöbinger分期系统的规模进行组织. 并不是所有的AVMS都会经过每一个阶段.

• 第一阶段(静止):AVM处于“安静”状态.“AVM顶部的皮肤可能是温暖的粉红色或红色.
• 第二阶段(扩张):AVM变大. 在AVM中可以感觉到或听到脉搏.
• 第三阶段(破坏):AVM引起疼痛、出血或溃疡.
• 第四阶段(失代偿):发生心力衰竭.

动静脉瘘(AVF)

动静脉瘘(AVF)与动静脉瘘相似. 它是动脉和静脉之间的异常连接. 你可能天生就有AVF, 但AVF通常是在事故发生后发生的, 创伤，甚至是手术后. The goal of treating an AVF is to close down the abnormal connection between the artery and the vein. AVF可以由同时治疗avm的专家治疗.

症状

动静脉畸形的症状取决于畸形的位置. 动静脉血栓有很高的出血风险. 随着人的成长，动静脉畸形会变得更大. 它们通常在青春期、怀孕或外伤后变大. 有动静脉畸形的人有疼痛的风险, 溃疡, 出血和, 如果AVM足够大, 心脏衰竭.

An AVM can be mistaken for a capillary malformation (often called a "port wine stain") or an infantile hemangioma.

这些是生理症状:

• 耳朵里嗡嗡作响的声音
• 头痛——虽然没有明确的头痛类型
• 背痛
• 癫痫发作
• 失去知觉:身体部分失去知觉
• 肌肉无力
• 视力变化
• 面瘫
• 下垂的眼睑
• 问题说
• 嗅觉的变化
• 运动问题
• 头晕
• 失去知觉
• 出血
• 疼痛
• 手指或脚趾发冷或发蓝

动静脉畸形的并发症包括:

• 中风
• 麻木:身体部分麻木
• 言语或行动方面的问题
• 儿童发育迟缓
• Hydrocephalus (accumulation of spinal fluid within the brain due to pressure on the normal spinal fluid pathways)
• 生活质量下降
• 出血死亡的风险很小

什么时候打电话给医疗保健提供者

有些人只有在动静脉畸形出血时才发现它. 这会导致一些人中风. 如果你注意到癫痫等症状, 麻木, 呕吐或身体虚弱, 立即去急诊室或拨打911寻求帮助. 然而, 任何怀疑AVM的时候, 你应该联系卫生保健提供者, 即使没有明显的症状.

诊断

Doctors can diagnose many AVMs by reviewing the patient's history and looking at the affected area (history and physical exam). 一般来说，avm不是遗传性的(不会从父母传给孩子)。.

AVMs有时会被误认为是婴儿血管瘤(IH)。. 当孩子不再是婴儿时，AVM就会变大. his只在婴儿期生长.

AVMs can sometimes be mistaken for capillary malformations (CMs), commonly called "port wine stains". The difference is that an AVM has fast-flowing blood in the larger blood vessels underneath the skin. CM的血管很小，而且只存在于皮肤的顶层.

The final diagnosis, however, is usually made based on imaging tests that show areas of blood flow. An ultrasound is often the first test ordered when there is suspicion that a person might have an AVM. An ultrasound uses sound waves to make a picture of the blood vessels and tissues under the skin. It can also be used to detect the speed of blood flow, which helps doctors diagnose an AVM.

Ultrasound is a good method for young children because it doesn't require putting a child to sleep with anesthesia, 而且完全无痛.

动静脉畸形的图像会显示许多弯曲、弯曲的动脉和宽静脉. 血液从动脉流向静脉的速度非常快.

核磁共振成像 提供了更详细的关于AVM在体内的大小和位置的图片. 核磁共振也能显示其他重要的东西, 比如神经, 在动静脉畸形附近，可能会受到治疗的影响.

A CT 扫描将显示AVM是否影响骨头. CT扫描类似于核磁共振成像，只不过它使用的是x射线而不是磁场.

An angiogram may be ordered to give a very detailed picture of the blood vessels. 血管造影是在全身麻醉下进行的. They can be used to diagnose and "map" the blood vessels in an AVM and are also used during treatment of an AVM.

治疗

动静脉畸形是良性的，这意味着它们不是癌症. 治疗 of an AVM is focused on managing the symptoms and improving the life of the patient. 目前还没有药物被证明可以治愈动静脉畸形.

一组医生将一起工作来治疗动静脉畸形. An interventional radiologist is a doctor who can read pictures and scans of the body and use these images to treat an AVM. 这个医生将在诊断和治疗你的动静脉畸形方面发挥作用. 外科医生也可能参与其中.

治疗动静脉畸形的决定是由医生和推荐十大正规网赌平台共同做出的. 患者的年龄和AVM的大小, 地点和舞台都是决策过程的一部分. 如果AVM没有对患者造成问题(疼痛或功能丧失), 然后医生可能会建议定期随访.

因为动静脉畸形会随着时间的推移而扩大, 一旦AVM开始产生问题, 医生通常会开始治疗. 如果AVM位于敏感或危险区域, 医生可能会尽早讨论治疗方案，而不是等待. 许多患有动静脉畸形的患者在儿童或青少年时期接受治疗. 尽管一些治疗AVM的药物正在测试中, 目前还没有药物被证明可以治疗动静脉畸形.

动静脉畸形的栓塞和硬化治疗

栓塞和硬化治疗是AVM最常见的治疗方法. 栓塞和硬化治疗可以减小动静脉畸形的大小和症状. 他们不能让AVM完全消失.

在栓塞, 医用胶等材料, metal coils or even plugs are put into the center of the AVM through a tube called a catheter, 是通过血管插入的吗. 这些物质有助于阻止血液流动. For an AVM, embolization is often done through an artery or a vein connected to the AVM. When an AVM is blocked, blood stops flowing into it, and this helps shrink the AVM.

在硬化疗法, a liquid medicine called a sclerosant is injected into the AVM to destroy the vessels and cause scars to form. 这个过程也会导致AVM的血流量减少或没有血流量. 硬化疗法常用于治疗其他血管畸形, 比如静脉畸形和淋巴畸形.

During sclerotherapy, a doctor will use ultrasound and X-ray imaging to target the AVM.

Embolization and sclerotherapy are not cures for AVM, but rather, are used to manage AVM. 它们有助于缓解症状，使AVM变小. 随着时间的推移，AVM可能会重新扩大. 大多数患者一生中都会接受多次这种治疗. 我们的目标是尽可能地限制症状.

Sometimes, embolization and sclerotherapy to treat AVM are done together to get the best result.

溃疡, 意思是皮肤上有开放性伤口, 栓塞/硬化治疗最常见的并发症是什么. 如果发生溃疡，你的医生会治疗它.

Another less common complication of embolization/sclerotherapy is damage to a nearby nerve. 这可能会导致麻木或缺乏力量，通常是暂时的.

治疗准备

Your doctor and the treatment team will prepare you for what happens normally after the procedure. 他们会和你谈谈好处和风险.

通常, during the procedure the patient is asleep under general anesthesia given by a doctor called an anesthesiologist.

Some patients can go home the day of the procedure; some stay in the hospital to recover overnight or for longer.

Multiple treatments are often needed and are usually spaced about six weeks apart or more. 治疗后, 可能会有肿胀, 皮肤刺激和治疗部位的瘀伤.

对于一些动静脉畸形，手术是一种选择. 在动静脉畸形手术中，大量失血是一种风险. Embolization or sclerotherapy is sometimes done before surgery to decrease the risk of bleeding. Surgery for AVMs should be done only by surgeons with experience in treating these complicated conditions.

预防

动静脉畸形发生在出生前或出生前不久. 因为病因不明，你无法预防. 最好的方法是对上面列出的症状迅速作出反应.