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Malformacje tętniczo-żylne przyczyną owrzodzeń i krwotoków

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Malformacje tętniczo-żylne to rzadkie malformacje naczyniowe, występujące na skórze lub narządach wewnętrznych. Mogą być przyczyną guzów, owrzodzeń i krwotoków. Jak przebiega leczenie tego rodzaju zaburzeń i z jakimi chorobami mogą być związane?

Malformacje naczyniowe występują u 1-2% populacji. Są obecne od urodzenia i nie zanikają samoistnie. Malformacje tętniczo-żylne (ang. arteriovenous malformations, AVM) to rzadka odmiana malformacji naczyniowych. Są tworzone przez tętnice i żyły połączone poprzez naczynia włosowate lub anastomozy tętniczo-żylne. Należą one do malformacji szybkoprzepływowych. Najczęstszą lokalizacją malformacji tętniczo-żylnych jest wnętrze czaszki. Obecność malformacji tętniczo-żylnych ujawnia się najczęściej w okresie pokwitania.

Obraz kliniczny malformacji tętniczo-żylnych

Malformacje tętniczo-żylne mogą się lokalizować zarówno w obrębie narządów wewnętrznych, jak i na skórze.

W przypadku wystąpienia zmian w obrębie narządów wewnętrznych mogą one powodować zaburzenia hemodynamiczne takie jak przerost komory serca lub niewydolność serca. Jeżeli malformacje występują w obrębie twarzoczaszki, mogą stać się przyczyną przerostów i deformacji szczęki i żuchwy. Zmiany wewnątrzczaszkowe mogą doprowadzić do krwotoku śródmózgowego lub podpajęczynówkowego oraz napadów padaczkowych. U wielu chorych malformacje są również odpowiedzialne za bóle głowy.

W przypadku zmian na skórze malformacje tętniczo-żylne przybierają postać ucieplonego, wypukłego guza z towarzyszącym obrzękiem lub stanem zapalnym. Zmiany mogą ulegać wrzodzeniu i krwawieniu.

Malformacje tętniczo-żylne mogą występować w przebiegu zaburzeń rozwojowych z grupy fakomatoz takich jak zespół Sturge’a-Webera, zespół Klippla-Trénaunaya-Webera, zespół Oslera-Webera-Rendu oraz schorzeń tkanki łącznej (zespół Ehlersa-Danlosa, zespół Marfana).

Leczenie malformacji tętniczo-żylnych

Najczęściej stosowaną metodą terapii malformacji tętniczo-żylnych jest embolizacja wewnątrznaczyniowa. W części przypadków nie istnieje możliwość radykalnego leczenia. W takiej sytuacji wykonuje się jedynie częściowe zamknięcie przetok naczyniowych. W leczeniu AVM stosuje się również otwarte zabiegi chirurgiczne oraz radiochirurgię stereotaktyczną (zabiegi z miejscowym wykorzystaniem promieniowania jonizującego).

Źródła:

W. Jaroń, A. Mikołajczyk, A. Łątkowska, „Naczyniaki i malformacje naczyniowe”, „Chirurgia Plastyczna i Oparzenia” 2018, 6(3): 71-78.

A. Acewicz, P.S. Richter, “Bóle głowy w malformacjach naczyniowych mózgu”, „Neurologia po Dyplomie” 2013, 8(5): 14-18.

Przeczytaj także: Badanie: immunoterapia w onkologii a zmiany skórne

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