Angioarchitecture and hemodynamics of microvascular arterio-venous malformations

Arteriovenous malformations (AVMs) are characterized by pathological high flow, low resistance connections between arteries and veins. Treatment is critically dependent on correct interpretation of angioarchitectural features. However, some microfistular AVMs do not match the characteristics describ...

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Bibliographic Details
Published in:PloS one 2018-09, Vol.13 (9), p.e0203368-e0203368
Main Authors: Frey, Sabrina, Cantieni, Tarcisi, Vuillemin, Nicolas, Haine, Axel, Kammer, Rafael, von Tengg-Kobligk, Hendrik, Obrist, Dominik, Baumgartner, Iris
Format: Article
Language:English
Subjects:
Advection
Advection-diffusion equation
Arteries
Arteriovenous malformations
Biology and Life Sciences
Biomedical engineering
Blood
Capillaries
Circulatory system
Classification systems
Computation
Computer applications
Computer simulation
Contrast agents
Engineering research
Flow resistance
Hemodynamics
High flow
Lesions
Low resistance
Medicine and Health Sciences
Microvasculature
Musculoskeletal system
Physical Sciences
Prognosis
Propagation
Subgroups
Travel time
Ultrasonic imaging
Veins & arteries
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Summary:Arteriovenous malformations (AVMs) are characterized by pathological high flow, low resistance connections between arteries and veins. Treatment is critically dependent on correct interpretation of angioarchitectural features. However, some microfistular AVMs do not match the characteristics described in current AVM classification systems. Therefore, we propose a new subgroup of microfistular AVMs, composed of enlarged, fistulous paths on the venous half of capillaries and/or dilated draining venules (hyperdynamic, capillary-venulous malformation [CV-AVM]). CV-AVMs still ensure arterial flow to the periphery and fistulous venous drainage is less pronounced than in classical AVMs such that these lesions are often misinterpreted as venous malformations. We developed a computational model to study the effects of microvascular anomalies on local hemodynamics, as well as their impact on angiographic contrast propagation. Flow rates and pressures were computed with a lumped parameter description, while contrast propagation was determined by solving the 1D advection-diffusion equation. For the newly proposed CV-AVM angioarchitecture, the computational model predicts increased arterio-venous contrast agent transit times and highly dispersive transport characteristics, compared to microfistular, interstitial type IV AVMs and high flow type II and III AVMs. We related these findings to time-contrast intensity curves sampled from clinical angiographies and found that there is strong evidence for the existence of CV-AVM.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0203368