Background
AVMs may present at any age and are the least common vascular
malformation diagnosed in children (69). An AVM is a high flow lesion
and occurs when an artery directly connects to the venous system and
bypasses the capillary beds. The natural history of these abnormal
vascular connections is progressively ectatic veins due to the high
velocity blood flow, with eventual rupture. Rupture is the most feared
complication for any AVM and therefore intervention is almost always
warranted. The rate of rupture is higher in children when compared to
adults, making timely intervention of higher consideration (70). High
flow through AVMs can lead to hypoperfusion, hypoxic ischemia, and pain,
in a phenomenon known as steal syndrome (71).