Chulalongkorn Medical Journal


Problem/background : Hemorrhage is the most significant risk in patients with brainarteriovenous malformations (AVMs). Although several factorshave been found associated with hemorrhagic events, it is notknown with certainty whether specific angioarchitectural aspectpredispose patients with brain AVMs to any specific clinicalpresentation.Objective : The purpose of this study was to assess demographic, clinicaland morphological characteristics of patients with brainarteriovenous malformations and to identify significant factorsrelated to the initial hemorrhagic presentation.Design : Descriptive study.Setting : Department of Radiology, Faculty of Medicine, ChulalongkornUniversityMaterial and Methods : Clinical and angiographic data from 104 patients with brainAVMs at King Chulalongkorn Memorial Hospital wereretrospectively reviewed. Angiographic architectures such as,size, location, arterial supply and venous drainage pattern wererecorded. Univariate and multivariate analyses were conductedin order to test the association between the morphologicalfeatures and clinical presentation.Results : From a total of 104 patients, hemorrhage was an initial presentationin 64 cases (61.5%). By univariate analysis, small nidus size(p = 0.0001), single feeding artery (p = 0.0003), single drainingvein (p <0.0001) and deep venous drainage (p = 0.002) wereassociated with hemorrhage. When we used stepwise multiplelogistic regression analysis, single feeding artery (OR 6.68,95%CI 1.39 to 32.08; p = 0.018) and single draining vein (OR5.24, 95%CI 2.04 to 13.47; p = 0.001) were independentlyassociated with hemorrhage.Conclusions : Single feeding artery and single draining vein were significantfactors associated with initial hemorrhagic presentation. Incontrast with many previous reports, AVM size, location, andpresence of deep venous drainage were not associated withhemorrhage at presentation in adjusted analyses.

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