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Hemodynamics of AVM

December 04, 2014


This short video focuses on describing the basic Hemodynamics of an Arteriovenous Malformation. This is a 32 year old male who presented with a small right funnel arteriovenous malformation, again, the location and the size of the malformation is not important. In this case, I like to focus on the changes related to the arterialized vein. The malformation is located just underneath the cortex. Here's the arterialized vein. You can see, the slightly redder appearance of the draining vein. This is a normal appearing vein, and this is the very early stages of flouricine entering their arterial system. Let's go ahead and see the changes that occur upon injection of the flouricine. You can see the arterials and the small arteries appear to fill first. The normal veins remain unfilled. Next, the arterialized vein appears enhancing. In other words, the normal veins remain non-enhancing, emphasizing the fact that the lack of capillary system in the nidus of the formation leads to shunting of blood from the arterial system directly to the venous system, and therefore leads to early filling of the arterialized vein late in the arterial phase of the angiogram. The brain is also enhancing. Next, the normal vein starts to fill, as you can see here. And the reverse is true when the contrast clears. In other words, the small arteries clear first, followed by the vein and followed finally, by the normal draining vein. Here, you can see the brain is in the process of clearing the contrast. The arterialized vein also continues to slowly clear the contrast however the normal cortical veins, continue to maintain their enhancing feature. Therefore, this video describes the hemodynamic changes that occur within the malformation and the abnormal arteriovenous shunting present in AVMs. Thank you.

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