Research Assessment #20

Date: Nov 1, 2018

Subject: Arteriovenous Malformation

MLA Citation:

“Arteriovenous Malformation.” Mayo Clinic, Mayo Foundation for Medical Education and
Research, 23 Dec. 2017, www.mayoclinic.org/diseases-conditions/arteriovenous-
malformation/symptoms-causes/syc-20350544.

Analysis:

As I started my journey on the research that I have been doing about a year ago, I
always wanted to be the student that knew the diseases that people didn’t talk about much. I
had always been intrigued by the way these diseases are named or what they look like and that
is what got me into neurosurgery initially. However, as I progressed throughout the past year, I
noticed that not only did I learn new information that most people don’t know too much about,
but I was also seeing them in the real world. Something that I wasn’t able to see yet is a disease
called Arteriovenous Malformation (AVM). I had briefly looked over what it was while I was
searching up what a Chiari malformation was when I was with my mentor, but I couldn’t grasp
what this really was. As I researched into the disease, I started to learn new facts about the brain
itself and what makes it such a fragile organ.

First, I learned that an AVM can happen anywhere within the body where there are
centralized veins or arteries that could get mixed up like in the arm or a leg of a person. Mayo
Clinic describes the disease as an “abnormal tangle of blood vessels connecting arteries and
veins, which disrupts normal blood flow and oxygen circulation.” This specifically means that
when there is a location of the body that gets injured and then someone feels “tangled up” that
is when the body response changes to this disease. There are usually symptoms of a migraine,
which is a sharp headache that can cause people to have blurry vision, or even seizures where a
person would collapse and start vigorously shaking while sometimes foaming at the mouth.
This is for a regular AVM though as explained and can occur anywhere, but when it occurs in
the brain, the situation is much bigger than it ever was.

Also explained in the article below that “[w]hen an AVM disrupts this critical process,
the surrounding tissues may not get enough oxygen, and the affected arteries and veins can
weaken and rupture. If the AVM is in the brain and ruptures, it can cause bleeding in the brain
(hemorrhage), stroke or brain damage.” This is extremely important because hemorrhaging
within the brain can be a moment for life or death for a person. They could first feel the same
symptoms explained above, but also have much higher responses to various things based on
where this cluster/bundle of veins have been caught up in the brain. The main risk that is
obvious to the eye is being able to detach the bundle of veins or arteries that have been caught
up in such a soft area of the body. Due to each one being so close to the brain, the chances of not
releasing a fold within the brain rather than the arteries/veins is slim to none. this is why there
are specific professionals that can work on AVMs as mentioned below in the article. Due to the
fact that this is because the procedure being done is rare in the first place, with a recorded
200,000 cases or less annually meaning right around 0.003% of the population has been
diagnosed with this condition and have gotten it fixed or having to go through the symptoms
mentioned above.

Obviously, the neurosurgeon with the most experience would perform this surgery and
he would be able to get this surgery done in no time. Wrong, the neurosurgeon with the
experience in performing craniotomies can only perform this surgery with the help of a
cardiovascular surgeon. A regular neurosurgeon that has been through a painstakingly 20 years
of education is not fit for the job unless he/she has practiced on the head region before. The
main reason a cardiovascular surgeon should be present when this surgery is being performed
is because there are major bundles of arteries/veins that connect the brain to the heart that if by
mistake messed around with, could cause a patient to automatically go into cardiac arrest.
That’s why with the help of a cardiovascular surgeon, there would be someone to distinguish
the different lines within the brain and cut and reconnect the main lines without harming the
patient.

I started to see how the world is interconnected and as we sometimes ignorantly think
that we would never see another specialized surgeon after medical school, we would often
work with them to solve specific problems. This is very eye opening because I was able to see
not only are diseases suffered by people across the world rare and hard to treat and that many
of them just live their lives with it in their heads because it costs too much to get it treated at a
hospital. It makes me wonder how money has really influenced the way a person decides the
way a person wants to live or die. As I learned throughout the past year every career is
connected and we never know when we would have to work together to save a patient’s life.

(Article starts on Page 3 below.)

 Overview

AVM blood flow

An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels
connecting arteries and veins, which disrupts normal blood flow and oxygen circulation.

Arteries are responsible for taking oxygen-rich blood from the heart to the brain. Veins
carry the oxygen-depleted blood back to the lungs and heart.

When an AVM disrupts this critical process, the surrounding tissues may not get enough
oxygen, and the affected arteries and veins can weaken and rupture. If the AVM is in
the brain and ruptures, it can cause bleeding in the brain (hemorrhage), stroke or brain
damage.

An arteriovenous malformation can develop anywhere in your body but occurs most
often in the brain or spine. Read more about brain arteriovenous malformation.

The cause of AVMs is not clear. Most people are born with them, but they can
occasionally form later in life. They are rarely passed down among families.

Once diagnosed, a brain AVM can often be treated successfully to prevent or reduce
the risk of complications.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means
to prevent, detect, treat or manage this disease.

Departments and specialties

Mayo Clinic has one of the largest and most experienced practices in the United States,
with campuses in Arizona, Florida and Minnesota. Staff skilled in dozens of specialties
work together to ensure quality care and successful recovery.

Departments that treat this condition

 Cardiovascular Medicine
 Cardiovascular Surgery

 Neurology

 Neurosurgery

 Radiology

Areas that research this condition

 Department of Neurosurgery — Research

 Neurology Research

 Radiology Research

Arteriovenous malformation care at Mayo Clinic

Your Mayo Clinic care team

At Mayo Clinic, neurologists, neurosurgeons, neuroradiologists and other specialists

work together as a multidisciplinary team to provide expert, individualized care to every
person with AVM. This means that you're not getting just one opinion — you benefit
from the knowledge and experience of each specialist.

Mayo Clinic specialists perform a thorough exam of each person that is tailored to the
person's specific symptoms and condition. Our AVM experts will take as much time as
necessary to explain, interpret and guide you through the process.

Close collaboration enables the team to have your test results available quickly and to
coordinate all necessary appointments. Evaluation and treatment that might take weeks
elsewhere can typically be done in only a matter of days at Mayo Clinic.

Advanced diagnosis and treatment

At Mayo Clinic, people with AVM experience:

 Advanced imaging studies. MRIs and other types of brain imaging are crucial to
effective treatment. Mayo Clinic neuroradiologists devote their careers to
 evaluating brain conditions. This deep experience results in more-accurate imaging
and interpretation.

 Expert treatment. Mayo Clinic neurosurgeons have pioneered surgical techniques

for AVM as well as noninvasive stereotactic radiosurgery. This expertise in surgery
and noninvasive treatment as well as in embolization and watchful waiting allows
the AVM team at Mayo Clinic to provide the widest range of treatment options
available.

 Innovation. With state-of-the-art research and laboratory facilities, Mayo Clinic

experts are constantly seeking new medical knowledge and innovations for people
with AVMs. Today's research teams are studying potential treatments, including
new surgical options, and better ways to predict risk of hemorrhage in people with
AVMs. A variety of clinical trials and other clinical studies may be available to you
at Mayo Clinic.

 Coordinated care. Mayo doctors can work closely with your local doctor to
coordinate treatment and follow-up care.
Nationally recognized expertise

Mayo Clinic in Rochester, Minn., ranks No. 1 for neurology and neurosurgery in the U.S.
News & World Report Best Hospitals rankings. Mayo Clinic in Phoenix/Scottsdale, Ariz.,
and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals for
neurology and neurosurgery by U.S. News & World Report. Mayo Clinic also ranks
among the Best Children's Hospitals for neurology and neurosurgery.

Expertise and rankings

Mayo Clinic doctors have extensive expertise and experience in evaluating and treating
arteriovenous malformations. Our experts evaluate and treat more than 300 people with
arteriovenous malformations each year.

Mayo Clinic neurosurgeons have pioneered surgical techniques for AVM as well as
noninvasive stereotactic radiosurgery. This expertise in surgery and noninvasive
treatment as well as in embolization and watchful waiting allows the AVM team at Mayo
Clinic to provide the widest range of treatment options available.
Locations, travel and lodging

Mayo Clinic has major campuses in Phoenix and Scottsdale, Arizona; Jacksonville,
Florida; and Rochester, Minnesota. The Mayo Clinic Health System has dozens of
locations in several states.