Arteriovenous malformation in the pregnant patient: a case study

Subarachnoid hemorrhage (SAH) due to ruptured arteriovenous malformation (AVM) or aneurysm accounts for 4.4% of all maternal deaths. It is the third most common nonobstetric cause of maternal death. Significant differences, such as timing of the initial bleed and rebleeding, exist between aneurysmal and AVM related SAH. Increased risk of AVM related SAH appears to correlate with the augmented cardiac output of pregnancy, as well as with other coagulation, hemodynamic and endocrinological changes. These changes usually occur between 20 weeks gestation and 6 weeks postpartum. All suspicious neurological signs and symptoms in the gravid patient should be thoroughly evaluated. Although the nursing care of the pregnant patient with an AVM is similar to that of nonpregnant patients, there are specific clinical observations that are relevant to these patients.

Endovascular therapy of neurovascular malformations

The development of microcatheters and newer embolytic agents has made it possible to treat persons with arteriovenous malformations, arteriovenous fistulas and aneurysms. Until recently, endovascular embolization was usually performed to devascularize tumors prior to surgical removal. The growing number of neurovascular conditions that can be treated by endovascular embolization has led to the need for neuroscience nurses to be knowledgeable about indications, materials, methods, risks, patient preparation and nursing implications in the care, education and discharge planning for the embolization patient.

Intracerebral arteriovenous malformations presenting as neonatal congestive heart failure

Intracerebral arteriovenous malformations (AVM) are a complex medical emergency in neonates. AVMs are congenital communications between the arterial and venous circulation. Occurring early in gestation, they may enlarge over time, promulgating a left-to-right shunt. This volume overload can present as severe congestive heart failure or as pronounced shock. This article discusses the pathophysiology, clinical presentation, diagnostic modalities, treatment regimens, nursing implications, and complications of cerebral AVMs. A case study is also presented.

Radiosurgery: a nursing perspective

The term radiosurgery, originally applied to three-dimensional stereotactic irradiation of small intracranial targets with low-energy x-rays, has more recently been applied to widely differing techniques and radiation sources. These include gamma units using cobalt-60; beams of protons, helium ions and neutrons; and modified cobalt-60 or linear accelerator units. These techniques allow delivery of a high dose of radiation in a single fraction to a small and well-defined intracranial volume, without delivering significant radiation to adjacent normal tissue. The most usual targets for radiosurgery are arteriovenous malformations. It is occasionally used for acoustic neuromas and primary or metastatic brain malignancies as well. Although radiosurgery is not a new procedure, its use is becoming more widespread. Nurses, as critical members of radiosurgery teams, must be informed about all aspects of the procedures and associated nursing care skills.

Transcatheter arterial embolization of cerebral arteriovenous malformations

An arteriovenous malformation (AVM) is a tangled mass of arteries and veins. These abnormal dilated vessels shunt blood away from normal brain tissue, resulting in adjacent tissue damage. In the past surgical removal of an AVM was often complicated by hemorrhage. In some cases the location or size of an AVM made it unresectable. The risks of surgical removal have led to the development of alternative approaches for the treatment of AVMs, such as transcatheter arterial embolization therapy. A variety of substances can be introduced via a catheter to occlude the abnormal vessels and obliterate the AVM or to decrease size to ease surgical management. This article discusses patient selection for embolization therapy, the materials and methods used and related nursing care and patient education. A case history is presented.

Arteriovenous malformations: complications of surgical intervention and implications for nursing

Arteriovenous malformations occur in approximately 4 percent of the population and are frequently seen in young adulthood. Controversy exists in the neurosurgical community as to the management of arteriovenous malformations; the four most common methods are medical management, radiation, embolization, and surgical intervention. Complications occur frequently regardless of the treatment selected. These complications are discussed using a selected patient population and case studies. Nursing diagnosis is used and a plan of care formulated for each problem. A one-year follow-up status will also be given for the selected patient population.