动静脉畸形(AVMs)发生时，一组血管在你的身体不正确的形成. In these malformations, arteries and veins are unusually tangled and form direct connections, bypassing normal tissues. This usually happens during development before birth or shortly after.

Most people with AVMs have no initial symptoms or problems. 相反，当卫生保健提供者治疗另一个不相关的健康问题时，才会发现这个问题. 有时，AVM中一根血管的破裂会引起医学上的关注. Sometimes AVMs are only found after death, during an autopsy.

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© Eleanor Bailey

Facts About AVMs

Most people with AVMs will never have any problems. If symptoms have not appeared by the time a person is 50, they may never appear. 女性有时会因为怀孕给血管带来的负担而出现症状. Nearly 12 percent of people with AVMs do have some symptoms, however.

No one knows why AVMs form. Some experts believe that the risk of developing AVMs could be genetic. AVMs can form anywhere in the body. Those that form in the brain or close to the spinal cord, called neurological AVMs, are most likely to have long-term effects.

与动静脉畸形有关的最大担忧是它们会导致无法控制的出血或出血. 只有不到4%的动静脉畸形出血，但那些出血的人可能会产生严重甚至致命的影响. 大约1%的动静脉畸形患者会直接死于动静脉畸形.

有时动静脉畸形会减少进入大脑和脊髓的氧气量(这有时被称为“偷窃”效应), as if the blood were being "stolen" from where it should be flowing). AVMs can sometimes put pressure on surrounding tissues. 偷窃也可能发生在身体的其他部位，如手或脚，但可能不那么明显.

当身体某一部位的动脉和静脉没有正确形成时，就会发生动静脉畸形. Normally arteries take blood from the heart to the body. 带着新鲜氧气和营养物质的血液通过动脉进入被称为毛细血管的微小血管. Through these tiny vessels, blood travels into the body's tissues. Blood then leaves the tissues through the capillaries and empties into veins, which bring blood back to the heart. Capillaries are tiny vessels that help the blood to slow down. This allows the blood to deliver oxygen and nutrients into tissues.

In an AVM, there are no capillaries, so blood does not slow down, and it does not get to deliver oxygen and nutrients to the body's tissues. 相反，流动非常快(高流量)的血液直接从动脉流向静脉. Rarely, if there is a lot of flow through an AVM, it can cause the heart to work too hard to keep up, leading to heart failure.

Although present at birth, an AVM may be found soon after birth or much later in life, depending on its size and location. 动静脉畸形可能在事故发生后或随着儿童长大成人(在青春期)而变得明显。. As a patient's body grows, the AVM grows too.

AVMs grow and change over time. AVMs are often organized using a scale called the Schöbinger staging system. Not all AVMS go through every stage.

• Stage I (quiescence): The AVM is "quiet." The skin on top of the AVM may be warm and pink or red.
• Stage II (expansion): The AVM gets larger. A pulse can be felt or heard in the AVM.
• Stage III (destruction): The AVM causes pain, bleeding or ulcers.
• Stage IV (decompensation): Heart failure occurs.

Arteriovenous Fistula (AVF)

An arteriovenous fistula (AVF) is similar to an AVM. It is an abnormal connection between an artery and a vein. You can be born with an AVF, but often an AVF will develop after an accident, trauma or even after a medical procedure. 治疗AVF的目的是关闭动脉和静脉之间的异常连接. An AVF can be treated by a specialist who also treats AVMs.

Symptoms

Symptoms of AVMs depend on where the malformation is located. AVMs have a high risk of bleeding. AVMs can get bigger as a person grows. They often get bigger during puberty, pregnancy or after a trauma or injury. A person with an AVM is at risk for pain, ulcers, bleeding and, if the AVM is large enough, heart failure.

AVM可能被误认为是毛细血管畸形(通常称为“葡萄酒斑”)或婴儿血管瘤.

These are physical symptoms:

• Buzzing or rushing sound in the ears
• Headache — although no specific type of headache has been identified
• Backache
• Seizures
• Loss of sensation in part of the body
• Muscle weakness
• Changes in vision
• Facial paralysis
• Drooping eyelids
• Problems speaking
• Changes in sense of smell
• Problems with motion
• Dizziness
• Loss of consciousness
• Bleeding
• Pain
• Cold or blue fingers or toes

Complications of AVMs include:

• Stroke
• Numbness in part of the body
• Problems with speech or movement
• In children, developmental delays
• 脑积水(由于正常脊液通路受到压力而导致脑脊液在脑内积聚)
• Lower quality of life
• Small risk for death from hemorrhage

When to Call the Health Care Provider

Some people only find out about an AVM when it bleeds. This causes stroke in some people. If you notice symptoms such seizure, numbness, vomiting or physical weakness, go immediately to the emergency room or call 911 to get help. However, any time an AVM is suspected, you should contact a health care provider, even without obvious symptoms.

Diagnosis

医生可以通过回顾推荐十大正规网赌平台的病史和观察受影响的部位(病史和体格检查)来诊断许多动静脉畸形。. In general, AVMs are not hereditary (not passed on from parent to child).

AVMs can sometimes be mistaken for infantile hemangioma (IH). An AVM gets bigger when the child is no longer a baby. IHs only grow during infancy.

AVMs有时会被误认为毛细血管畸形(CMs)，通常被称为“葡萄酒斑”。. 不同之处在于，AVM在皮肤下的大血管中有快速流动的血液. The blood vessels in a CM are small and in the top layers of the skin only.

然而，最终的诊断通常是基于显示血流区域的影像学检查. 当怀疑一个人可能患有动静脉畸形时，超声波通常是第一个检查. 超声波利用声波来绘制皮肤下血管和组织的图像. 它还可以用来检测血液流动的速度，这有助于医生诊断AVM.

超声波对小孩子来说是一种很好的方法，因为它不需要让孩子在麻醉下入睡, and it is completely painless.

动静脉畸形的图像会显示许多弯曲、弯曲的动脉和宽静脉. The blood will be seen to flow very quickly from the arteries to the veins.

MRI 提供了更详细的关于AVM在体内的大小和位置的图片. MRI also shows what other important things, such as nerves, are near the AVM and that may be affected by treatment.

A CT scan will show whether the AVM is affecting a bone. A CT scan is like an MRI, except it uses X-rays instead of magnetic fields.

血管造影可以提供血管的详细图像. Angiograms are done under general anesthesia. 它们可用于诊断和绘制动静脉畸形的血管图，也可用于动静脉畸形的治疗.

Treatment

AVMs are benign, which means they are not cancer. AVM的治疗重点是控制症状和改善患者的生活. There are no drugs yet that have been proven to cure an AVM.

A team of doctors will work together to treat an AVM. 介入放射科医生是一名能够读取图像和扫描身体并使用这些图像来治疗AVM的医生. This doctor will play a role in both diagnosing and treating your AVM. Surgeons may also be involved.

The decision to treat an AVM is made by both the doctor and the patient. The age of the patient and the AVM's size, location and stage are all part of the decision-making process. If an AVM isn't causing problems (pain or loss of function) for the patient, then doctors may recommend just regular follow-up visits.

Because AVMs can expand over time, once an AVM starts causing problems, doctors will often start treatment. If an AVM is in a sensitive or dangerous area, doctors may discuss treatment sooner instead of waiting. Many patients with an AVM get treated when they are a child or teenager. Although some medicines are being tested for the treatment of AVM, there are no medicines that have been proven to treat an AVM.

Embolization and Sclerotherapy Treatment for AVMs

Embolization and sclerotherapy are the most common treatments for AVM. Embolization and sclerotherapy can reduce the size and symptoms of an AVM. They cannot make the AVM go away completely.

In embolization, materials such as medical glue, 金属线圈或甚至是塞通过一根叫做导管的管子放入动静脉畸形的中心, which is inserted through a blood vessel. These materials help to block blood flow. 对于动静脉畸形，栓塞通常通过与动静脉畸形相连的动脉或静脉进行. 当AVM被阻塞时，血液停止流入它，这有助于缩小AVM.

In sclerotherapy, 一种被称为硬化剂的液体药物被注射到AVM中，以破坏血管并导致疤痕形成. This process also leads to less or no blood flow through the AVM. Sclerotherapy is often used to treat other vascular malformations, such as venous malformations and lymphatic malformations as well.

在硬化治疗期间，医生将使用超声和x射线成像来定位AVM.

栓塞和硬化治疗并不能治愈AVM，而是用于治疗AVM. They help with symptoms and make the AVM smaller. Over time, the AVM will likely re-expand. Most patients get this treatment several times throughout their life. The goal is to limit the symptoms as much as possible.

有时，栓塞治疗和硬化治疗一起进行，以获得最佳效果.

Ulceration, meaning an open wound on the skin, is the most common complication of the embolization/sclerotherapy procedure. If an ulcer occurs, your doctor will treat it.

栓塞/硬化疗法的另一个不太常见的并发症是损伤附近的神经. This may cause numbness or lack of strength and is usually temporary.

Preparing for Treatment

你的医生和治疗团队会为手术后的正常情况做好准备. They will talk with you about benefits and risks.

Typically, 在手术过程中，推荐十大正规网赌平台在全身麻醉下处于睡眠状态，由一名被称为麻醉师的医生进行麻醉.

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

通常需要多次治疗，间隔大约6周或更长时间. Following treatment, there could be swelling, irritation on the skin and bruising at the treated site.

For some AVMs, surgery is an option. Major blood loss is a risk during AVM surgery. 栓塞或硬化治疗有时在手术前进行，以减少出血的风险. 动静脉畸形的手术只能由具有治疗这些复杂疾病经验的外科医生进行.

Prevention

AVMs happen before birth or shortly thereafter. Because their cause is unknown, you can't prevent them. The best approach is to respond quickly to the symptoms listed above.