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Is embolisation necessary to treat AV malformations?

Q: I have an arterio-venous (AV) malformation in my right hand. There is a visible knot in my wrist. Two years back I underwent angiography wherein the doctors injected the dye to view of the complexity of AV malformation at the Ramachandra Hospital, Chennai. As a result I was suggested to undergo embolisation. I am not prepared to undergo this as I feel there is no surety. I get severe headaches and my hand gets warm. Nowadays it pains a lot too. My spouse is worried and wants me to undergo embolisation. We are also worried about the spread of the malformation to other places especially near the heart, can this happen? Please suggest what should be done?

A:1. AV malformations do not spread! They are congenital malformations that may increase over a period of time because of the circulatory haemodynamics. In doing so, they are liable to cause problems due to stealing of blood from the neighbouring area, bleeding and local changes depending on the organ involved. The heat sensation you feel in the same hand is one such problem. 2. The condition should be treated. 3. Angiography is the correct investigation for diagnosis and planning further treatment since it tells us as to which vessels are the culprits and how to manage them. 4. Embolisation and surgical excision (with ligation of the feeder vessels are the two methods of treatment. 5. With currently available facilities, embolisation is preferred over surgery in a good setup and with doctors who do it routinely. Ramachandra hospital has a very good facility of interventional radiology and they should be able to handle it well. 6. Headache may/may not be related to your AVM depending on which are the feeders and if there is any evidence of steal from vessels which would be supplying blood to the upper limb. This will depend on where in the upper limb is the AVM located. But you will have to confirm and discuss this with your doctor who has done the angiogram. If this does not explain it, then it would be good to see a neurologist for explanation.

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