2025 Proffered Presentations
S352: PEDIATRIC AVM-ASSOCIATED ANEURYSMS: 35-YEAR PITTSBURGH EXPERIENCE
Rachel C Jacobs, MD1; Akanksha Chilukuri, BS1; Hussam Abou-Al-Shaar, MD1; Joseph H Garcia, MD1; Prateek Agarwal, MD1; Michael M McDowell, MD1; Alhamza R Al-Bayati, MD1; Stephanie Greene, MD2; 1University of Pittsburgh Medical Center; 2Duke Children's Hospital
OBJECTIVE: Arteriovenous malformations (AVMs) are the leading cause of nontraumatic intracerebral hemorrhage (ICH) in children, accounting for 30-50% of all spontaneous hemorrhages in this population, often leading to devastating complications. The high proportion of pediatric spontaneous ICH cases attributable to ruptured AVM underscores the need to predict risk factors associated with AVM rupture. Current literature from the adult AVM population suggests that both younger age and associated aneurysms carry an increased risk of hemorrhagic presentation. However, detailed analysis of pediatric AVM-associated aneurysms and their link to ICH is relatively unknown, with the literature largely comprised of case reports. This study aims to determine whether AVM-associated aneurysms predispose pediatric patients to ICH. It is hypothesized that presentation with ICH is more likely in patients with AVMs with an associated aneurysm than in patients with isolated AVMs.
METHODS: A retrospective cohort study of 238 pediatric patients with arteriovenous malformations that presented to the Children’s Hospital of Pittsburgh from 1988-2023 was performed. Hospital records, patient charts, and radiographic imaging studies were reviewed for patient demographics, presentation status, and AVM architecture. All aneurysms were confirmed by digital subtraction angiography (DSA). All patients had a minimum follow-up of 6 monhs, and 75% of the cohort had a least 3 years of follow-up.
RESULTS: Of the 238 total patients, 44 (18.5%) children with AVMs had associated aneurysms. There were 19 (35.2%) feeding artery aneurysms, 8 (14.8%) intranidal aneurysms, 21 (38.9%) postnidal aneurysms, and 1 (1.9%) unrelated aneurysm. Five patients had venous varices. One hundred and forty children (58.8%) presented with hemorrhage. Twenty-one of 44 (47.7%) that had an AVM-associated aneurysm presented with hemorrhage, while 119 of 194 (61.3%) with a solitary AVM presented with hemorrhage (p = 0.10). On multivariate analysis, postnidal aneurysms (OR=0.36, p=0.037) and an increased number of draining veins (OR=0.66, p=0.049) were significantly associated with a decreased likelihood of hemorrhagic presentation. Deep venous drainage was associated with an increase in hemorrhagic presentation (OR=2.25, p=0.0045) on multivariate analysis.
CONCLUSION: Approximately one-fifth of children with AVMs in this study had accompanying aneurysms, and in this patient population, postnidal aneurysms and increased number of draining veins had a lower hemorrhagic presentation. Feeding artery and intranidal aneurysms were not associated with an elevated risk of hemorrhagic presentation.