ABSTRACT
Indications for Treatment Treatment of AVMs, especially high-flow AVMs, is challenging and not always successful regardless of the type of procedure chosen (percutaneous, surgical, or combined). Treatment should therefore be undertaken only when clinically indicated (3). Asymptomatic lesions that are discovered incidentally generally do not require treatment. Absolute and relative indications for treatment are as follows:
Absolute indications for treatment
l Hemorrhage, major or recurrent minor l Gangrene or ulcer of arterial, venous, or combined origin l Ischemic complication of acute and/or chronic arterial
insufficiency l Progressive venous complication of chronic venous insuf-
ficiency with venous hypertension l High-output cardiac failure (clinical and/or laboratory) l Lesion located at life-threatening vital areas that compro-
mise vision, hearing, eating, or breathing
Relative indications for treatment
l Various symptoms and signs affecting the quality of life; disabling pain and/or functional impairment
l Lesions with a potentially high risk of complications (e.g., hemarthrosis) and/or limb-threatening location
l Lesions causing limb length discrepancy l Cosmetically severe deformity with or without functional
disability
Principles of Treatment The mainstay of treatment of high-flow AVMs is permanently closing or eliminating the vascular nidus where arterial blood is shunted to the veins.
