Salman Khan suffers from Arteriovenous Malformations: What is it?

Along with Trigeminal Neuralgia and Brain Aneurysm, Bollywood actor Salman Khan also revealed that he has been suffering from Arteriovenous Malformations, commonly known as AVM Malformations. Making the revelation on ‘The Great Indian Kapil Show’ season 3 earlier this month, the ‘Bajrangi Bhaijaan’ actor has got many fans concerned about his health. 

With not much known about arteriovenous malformations, mid-day spoke to Dr Shaji Marar, consultant, Vascular & Interventional Radiology at Jaslok Hospital & Research Centre and Dr Pradyumna Oak, director, Neurology, Nanavati Max Super Speciality Hospital to highlight more about the condition. The health experts not only explain the causes but also the effects and how people suffering with arteriovenous malformations have to deal with it.

What are arteriovenous malformations (AVMs)?
Marar: Brain AVMs vascular malformation where arteries and veins connect directly, without the usual network of capillaries in between. This leads to a disruption in normal blood flow, potentially causing a range of complications. 

Oak: Arteriovenous malformations (AVMs) are abnormal connections between arteries and veins, which normally have tiny vessels called capillaries in between. In patients with AVMs, these capillaries are missing, causing blood to flow directly from arteries into veins. This creates a high-pressure, high-flow area called a ‘nidus.’ Such malformations usually form before birth and can occur anywhere in the body, commonly affecting the brain, head, neck, hands or legs.

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What causes arteriovenous malformations?
Marar: The exact cause of AVMs is not known but most are thought to be congenital, meaning they are present at birth and develop during foetal development.

Oak: AVM is a congenital condition, meaning it develops during the development of blood vessels in the embryo. This happens because some early blood vessel connections, which normally disappear during growth, remain abnormally open, causing direct arterial-to-venous blood flow. The condition can also be caused by genetic factors. 

What are the effects of arteriovenous malformations?
Marar: AVMs can cause a variety of effects, depending on their size, location, and whether they rupture. Some common effects include: 

Haemorrhage (bleeding): Ruptured AVMs can cause bleeding in the brain or spinal cord, leading to stroke, neurological damage, and sometimes death.
Neurological symptoms: Depending on the location, AVMs can cause headaches, seizures, muscle weakness, paralysis, balance problems, speech difficulties and vision problems. The abnormal blood flow can deprive surrounding tissues of adequate oxygen, potentially leading to brain tissue damage causing seizures or paralysis. 

Oak: AVMs can have several serious effects such as pain, skin changes, ulcers, and bleeding. Since blood flows directly from arteries to veins without reaching tissues effectively, areas around the AVM may suffer reduced oxygen supply. Some individuals with AVMs can experience serious side-effects such as tissue destruction, bleeding from ruptured vessels, deformities, and, in rare cases, stroke or heart failure due to increased workload. 

What are the treatment options?
Marar: Treatment options for AVMs vary depending on the individual`s situation and the characteristics of the AVM. These include: 

Observation: In some cases, particularly if the AVM is small and asymptomatic, one may opt for a “watch and wait” approach. 
Endovascular embolisation: This procedure involves using a catheter to deliver a substance that blocks the abnormal blood vessels. 
Microsurgical resection: Involves surgically removing the AVM. 
Stereotactic radiosurgery: Uses focused radiation to damage and eventually close off the AVM. 

Oak: Treatment of AVM depends on its size, location, and severity. In embolisation, experts block the blood flow into the AVM by injecting materials through a catheter, sclerotherapy works by injecting substances directly into the AVM to shrink it and surgery is also available to remove the AVM. Depending on your condition, experts may use a combination of these methods. 

What is the age group affected by AVMs and does this differ based on gender?
Marar: Though AVMs are thought to be congenital, they can affect individuals of any age, but symptoms often appear between the ages of 10 and 40. AVM show no significant gender predilection.

Oak: Though AVMs are present at birth, they typically become noticeable in childhood or adolescence as they grow and cause symptoms. Both men and women are affected equally and the condition can affect any age group.

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