arteriovenous

Arteriovenous malformations (AVMs) are defects in your vascular system. Your vascular system is your body's network of blood vessels. It includes your:

• Arteries, which carry oxygen-rich blood from your heart to your tissues and organs.
• Veins, which carry the blood and waste products back to your heart.
• Capillaries, which are tiny blood vessels that connect your small arteries to your small veins.

An AVM is an abnormal tangle of arteries and veins. They are connected to each other, with no capillaries between them. Without the capillaries, the blood flow from the arteries goes directly into the veins at a faster rate than normal. Because of this, the nearby tissue does not get all the oxygen it would normally get. This lack of oxygen can lead to tissue damage and the death of nerve cells and other cells. The fast rate of blood flow can also increase the blood pressure inside the arteries and veins. This can weaken the arteries and veins. A weakened artery or blood vessel could burst or leak blood.

AVMs are rare. The cause of AVMs is unknown. Most of the time, people are born with them. But sometimes they can appear shortly after birth or later in life.

The symptoms of AVM will depend on where the AVM is located. They can happen anywhere in the body, but they are more common in the brain or spinal cord. Most people with brain or spinal cord AVMs have few, if any, major symptoms. But if a weakened blood vessel bursts, it can spill blood into the brain (called a hemorrhage). Severe hemorrhages can cause a stroke and brain damage.

If an AVM is causing symptoms, they can include:

• Seizures
• Headache
• Pain in the area where the AVM is located
• Vision problems
• Muscle weakness
• Problems with movement and speech
• Confusion
• Dizziness
• Loss of consciousness

To find out if you have an AVM, your health care provider:

• Will ask about your symptoms and medical history.
• Will do a physical exam. This may include listening for a bruit. A bruit is whooshing sound caused by the rapid blood flow through the arteries and veins of an AVM.
• May order imaging tests, such as a CT scan, MRI, ultrasound, or cerebral angiography. For a cerebral angiography, you are injected with a special dye that helps the blood vessels in your brain show up on x-rays.

Treatments for AVMs will depend on factors such as:

• Where the AVM is located
• Its size
• Your symptoms
• Your overall health
• Your risk of bleeding

The treatment options may include:

• Monitoring for any signs that may mean you have an increased risk of hemorrhage.
• Medicines to help with the symptoms from AVMs.
• Surgery, which may be done if you have a higher-than-usual risk of bleeding. There are a few different types of surgery for AVMs. In some cases, you may have more than one type. Surgery can be risky, especially when it's done on the brain or spinal cord. So you and your provider will need to discuss the risks and benefits of doing the surgery before you make a decision.

NIH: National Institute of Neurological Disorders and Stroke

A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between the esophagus and the windpipe or the bowel and the vagina. They can also develop between two blood vessels, such as between an artery and a vein or between two arteries.

Some people are born with a fistula. Other common causes of fistulas include:

• Complications from surgery
• Injury
• Infection
• Diseases, such as Crohn's disease or ulcerative colitis

Treatment depends on the cause of the fistula, where it is, and how bad it is. Some fistulas will close on their own. In some cases, you may need antibiotics and/or surgery.

A brain aneurysm is an abnormal bulge or "ballooning" in the wall of an artery in the brain. They are sometimes called berry aneurysms because they are often the size of a small berry. Most brain aneurysms produce no symptoms until they become large, begin to leak blood, or burst.

If a brain aneurysm presses on nerves in your brain, it can cause signs and symptoms. These can include:

• A droopy eyelid
• Double vision or other changes in vision
• Pain above or behind the eye
• A dilated pupil
• Numbness or weakness on one side of the face or body

Treatment depends on the size and location of the aneurysm, whether it is infected, and whether it has burst. If a brain aneurysm bursts, symptoms can include a sudden, severe headache, nausea and vomiting, stiff neck, loss of consciousness, and signs of a stroke. Any of these symptoms requires immediate medical attention.

NIH: National Heart, Lung, and Blood Institute

A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Hemorrhagic stroke is the less common type. It happens when a blood vessel breaks and bleeds into the brain. Within minutes, brain cells begin to die. Causes include a bleeding aneurysm, an arteriovenous malformation (AVM), or an artery wall that breaks open.

Symptoms of stroke are:

• Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

It is important to treat strokes as quickly as possible. With a hemorrhagic stroke, the first steps are to find the cause of bleeding in the brain and then control it. Surgery may be needed. Post-stroke rehabilitation can help people overcome disabilities caused by stroke damage.

National Institute of Neurological Disorders and Stroke

A stroke happens when there is a loss of blood flow to part of the brain. Your brain cells cannot get the oxygen and nutrients they need from blood, and they start to die within a few minutes. This can cause lasting brain damage, long-term disability, or even death.

If you think that you or someone else is having a stroke, call 911 right away. Immediate treatment may save someone's life and increase the chances for successful rehabilitation and recovery.

There are two types of stroke:

• Ischemic stroke is caused by a blood clot that blocks or plugs a blood vessel in the brain. This is the most common type; about 80% of strokes are ischemic.
• Hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain

Another condition that's similar to a stroke is a transient ischemic attack (TIA). It's sometimes called a "mini-stroke." TIAs happen when the blood supply to the brain is blocked for a short time. The damage to the brain cells isn't permanent, but if you have had a TIA, you are at a much higher risk of having a stroke.

Certain factors can raise your risk of a stroke. The major risk factors include:

• High blood pressure. This is the primary risk factor for a stroke.
• Diabetes.
• Heart diseases.Atrial fibrillation and other heart diseases can cause blood clots that lead to stroke.
• Smoking. When you smoke, you damage your blood vessels and raise your blood pressure.
• A personal or family history of stroke or TIA.
• Age. Your risk of stroke increases as you get older.
• Race and ethnicity. African Americans have a higher risk of stroke.

There are also other factors that are linked to a higher risk of stroke, such as:

• Alcohol and illegal drug use
• Not getting enough physical activity
• High cholesterol
• Unhealthy diet
• Having obesity

The symptoms of stroke often happen quickly. They include:

• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden confusion, trouble speaking, or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden difficulty walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

If you think that you or someone else is having a stroke, call 911 right away.

To make a diagnosis, your health care provider will:

• Ask about your symptoms and medical history
• Do a physical exam, including a check of
  • Your mental alertness
  • Your coordination and balance
  • Any numbness or weakness in your face, arms, and legs
  • Any trouble speaking and seeing clearly
• Run some tests, which may include
  • Diagnostic imaging of the brain, such as a CT scan or MRI
  • Heart tests, which can help detect heart problems or blood clots that may have led to a stroke. Possible tests include an electrocardiogram (EKG) and an echocardiography.

Treatments for stroke include medicines, surgery, and rehabilitation. Which treatments you get depend on the type of stroke and the stage of treatment. The different stages are:

• Acute treatment, to try to stop a stroke while it is happening
• Post-stroke rehabilitation, to overcome the disabilities caused by the stroke
• Prevention, to prevent a first stroke or, if you have already had one, prevent another stroke

Acute treatments for ischemic stroke are usually medicines:

• You may get tPA, (tissue plasminogen activator), a medicine to dissolve the blood clot. You can only get this medicine within 4 hours of when your symptoms started. The sooner you can get it, the better your chance of recovery.
• If you cannot get that medicine, you may get medicine that helps stop platelets from clumping together to form blood clots. Or you may get a blood thinner to keep existing clots from getting bigger.
• If you have carotid artery disease, you may also need a procedure to open your blocked carotid artery

Acute treatments for hemorrhagic stroke focus on stopping the bleeding. The first step is to find the cause of bleeding in the brain. The next step is to control it:

• If high blood pressure is the cause of bleeding, you may be given blood pressure medicines.
• If an aneurysm if the cause, you may need aneurysm clipping or coil embolization. These are surgeries to prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.
• If an arteriovenous malformation (AVM) is the cause of a stroke, you may need an AVM repair. An AVM is a tangle of faulty arteries and veins that can rupture within the brain. An AVM repair may be done through
  • Surgery
  • Injecting a substance into the blood vessels of the AVM to block blood flow
  • Radiation to shrink the blood vessels of the AVM

Stroke rehabilitation can help you relearn skills you lost because of the damage. The goal is to help you become as independent as possible and to have the best possible quality of life.

Prevention of another stroke is also important, since having a stroke increases the risk of getting another one. Prevention may include heart-healthy lifestyle changes and medicines.

If you have already had a stroke or are at risk of having a stroke, you can make some heart-healthy lifestyle changes to try to prevent a future stroke:

• Eating a heart-healthy diet
• Aiming for a healthy weight
• Managing stress
• Getting regular physical activity
• Quitting smoking
• Managing your blood pressure and cholesterol levels

If these changes aren't enough, you may need medicine to control your risk factors.

NIH: National Institute of Neurological Disorders and Stroke

Your vascular system is your body's network of blood vessels. It includes your:

• Arteries, which carry oxygen-rich blood from your heart to your tissues and organs
• Veins, which carry the blood and waste products back to your heart
• Capillaries, which are tiny blood vessels that connect your small arteries to your small veins. The walls of the capillaries are thin and leaky, to allow for an exchange of materials between your tissues and blood.

Vascular diseases are conditions which affect your vascular system. They are common and can be serious. Some types include:

• Aneurysm - a bulge or "ballooning" in the wall of an artery
• Atherosclerosis - a disease in which plaque builds up inside your arteries. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.
• Blood clots, including deep vein thrombosis and pulmonary embolism
• Coronary artery disease and carotid artery disease, diseases that involve the narrowing or blockage of an artery. The cause is usually a buildup of plaque.
• Raynaud's disease - a disorder that causes the blood vessels to narrow when you are cold or feeling stressed
• Stroke - a serious condition that happens when blood flow to your brain stops.
• Varicose veins - swollen, twisted veins that you can see just under the skin
• Vasculitis - inflammation of the blood vessels

The causes of vascular diseases depend on the specific disease. These causes include:

• Genetics
• Heart diseases such as high cholesterol and high blood pressure
• Infection
• Injury
• Medicines, including hormones

Sometimes the cause is unknown.

The risk factors for vascular diseases can vary, depending on the specific disease. But some of the more common risk factors include:

• Age - your risk of some diseases goes up as you get older
• Conditions that can affect the heart and blood vessels, such as diabetes or high cholesterol
• Family history of vascular or heart diseases
• Infection or injury that damages your veins
• Lack of exercise
• Obesity
• Pregnancy
• Sitting or standing still for long periods of time
• Smoking

The symptoms for each disease are different.

To make a diagnosis, your health care provider will do a physical exam and ask about your symptoms and medical history. You may have imaging tests and/or blood tests.

Which treatment you get depends on which vascular disease you have and how severe it is. Types of treatments for vascular diseases include:

• Lifestyle changes, such as eating a heart-healthy diet and getting more exercise
• Medicines, such as blood pressure medicines, blood thinners, cholesterol medicines, and clot-dissolving drugs. In some cases, providers use a catheter to send medicine directly to a blood vessel.
• Non-surgical procedures, such as angioplasty, stenting, and vein ablation
• Surgery

There are steps you can take to help prevent vascular diseases:

• Make healthy lifestyle changes, such as eating a heart-healthy diet and getting more exercise
• Don't smoke. If you are already a smoker, talk to your health care provider for help in finding the best way for you to quit.
• Keep your blood pressure and cholesterol in check
• If you have diabetes, control your blood sugar
• Try not to sit or stand for up long periods of time. If you do need to sit all day, get up and move around every hour or so. If you traveling on a long trip, you can also wear compression stockings and regularly stretch your legs.