Answer:
The treatment of AVM's is often challenging and frustrating and can potentially be as life-threatening as the lesion itself. Guidelines for management include the following:
- Preoperative medical treatment of any underlying coagulation defect secondary to thrombotic consumption.
- Excision of the entire lesion when possible. Residual anomalous vascular tissue at the resection margins means a likely recurrence of the AVM.
- Therapeutic distal embolization under superselective angiographic control. Embolization should be considered only a preliminiary step to excision in most patients.
- Use of large marginal mattress sutures, profound hypotensive anesthesia, and cardiopulmonary bypass with deep hypothermic circulatory arrest can be used selectively in extreme instances to minimize intraoperative bleeding.
- Postexcisional soft-tissue reconstruction with axial or arterialized flaps.
Ligation of the feeding vessel only worsens the problem and should never be performed.