Arteriovenus Malfunction (AVM) -This is new to me!!

[Scoobster]

Ok folks,

This is a new one for me, so maybe some one more knowledgable can shed any light on this one.. I heard of this the other day, a condition called Arteriovenus Malfunction, no idea what it is apart from that its origin can be genetic and that not every 'doctor' would pick this up in a standard medical. The doctors most likely to pick this up would be a neurologist..

Have been trying to get information regarding the stance that the JAA/FAA and even other aviation authorities like CASA, Transport Canada etc would take in relation to flying and any information about the condition, the stance that should be taken by a pilot etc


Have to say im 'baffled' about this one :confused: Any doctors in the house?

Obliged as always :}

Scoobster

[Mac the Knife]

I think you mean an arteriovenous malformation.

These can be large or small, some may be congenital, significant or non-significant, multiple or single, and can affect any organ or part of the body. Most are small, in the skin, and not significant.

You'll have to be a bit more specific! - it's a bit like saying, "I've just heard of this thing called an aeroplane! Is it serious? Will it kill me?" :oh:

[Scoobster]

Hi Mac,
Yup, I did actually mean that :} ahh the wonderful life of medics huh :)
Yes, I guess I should have been more specific, without knowing much about it myself its hard being specific you see, but Il do my best..
I had a bimaxillary oesteotomies (jaw surgery) for malloclusion problems in 2002 which the FAA are aware of. I also had an appendictomy which the FAA are also aware of. Both of which have no significant impact upon the issue of an FAA Class 1 Medical.
After the jaw surgery in 2002, I noticed a permanent noise (what I now have found out to be a 'bruit') on the left side of my neck which I can hear in my left ear, however I wasnt aware that I had AVM and continued with my life as normal, completing university, going to work, sleeping, eating, etc whilst this noise remained in my head. Again, not affecting me in any way at all.
So being unware that I had AVM when I went for my FAA Class 1 in September 2004, the FAA AME (UK) also did not pick up on the 'bruit'. Furthermore, as requested by the FAA I underwent a neurological examination with a consultant neurologist regarding a visual field defect and he also did not pick up on this so called 'noise' (bruit). Having all the information the FAA made a decision and granted me a FAA Class 1 subject to taking an MFT.
In January 2005, I took it upon myself to go to a private neurologist through BUPA because I was concerned about this noise, having attended regualarly I later found out that I was diagnosed with AVM in the left side of my neck, consisting of mainly small (i think) but maybe mixed network.
The neurologist seems to think it is congenital but for me it raises a few questions:
1) My ethical dillema being whether I inform the FAA or not (I think it states in the CFR's that airmen are obliged to inform the authorities of any change in sick status), however as I have not started my training (not even for a PPL) is it still necessary?
I am unlikely to start training for at least another year or 2 as I am trying to raise the finance and have just come out of university.
There have been many cases where people have kept 'mum' about certain issues whilst they have them investigated and no one has been any wiser whilst they rectified the problem. On the other side of the coin, 'honesty is the best policy'.
2) Is AVM dangerous enough to kill some one? According to the National Institute of Neurological Disorders about 1% of the population who are diagnosed with AVM can die from a haemorrage/stroke.
Whether I fall into that 1% is to be seen?
3) Can the network be succesfully removed?
I have heard AVM is treatable using techniques such as MRI/MRA, Cathetar Angiography and Open Surgery? The dangers here are that some times the FAA/CAA may be reluctant to grant a medical if some one has undergone surgery, due to uncertainty regarding whether the problem will re-occur.
4) Is there any danger of AVM re-occuring?
5) Has anyone had any experience of the stance of the FAA/JAA regarding AVM?
Thanks
Scoobster

[Mac the Knife]

Can't answer the aviation stuff re the FAA 'cos I don't know the rules, but it isn't really an illness. Someone smarter than me will answer that.

The "bruit" (French for noise) is caused by turbulent blood-flow in the AVM.

It could be congenital. It could be an arteriovenous fistula associated with your maxillary surgery. Anyway, it's usually eminently treatable. Usually by threading a fine tube up to the AVM from the groin and either filling it with superglue, or fragments of PVA sponge or tiny metal coils, so causing it to clot up and close.

"Is there any danger of AVM re-occuring?"

It could. Congenital AVMs are a bit harder to treat than acquired/traumatic AVMs. Sometimes you need a second shot at it.

"According to the National Institute of Neurological Disorders about 1% of the population who are diagnosed with AVM can die from a haemorrage/stroke."

I think they're talking about AVM's in the brain. AFAIK your type of AVM doesn't present a significant danger. But some AVMs can enlarge and press on things they should'nt.

See a vascular surgeon who works in the head and neck area rather than a neurologist.

Good luck!

[Scoobster]

Hi Mac,

Thanks for the reply. Would you mind if I PM'd you to discuss this further? Also do you think there is anything I should be specifically discussing with the neurologist or vascular surgeon when I see him??

You mentioned it might be a traumatic AVM, well its interesting that you say that because in 1998 I was knocked down by a car, when I was crossing the road, I suffered a head injury and was knocked unconscious only after I tried to get up and walk away.

I have a clear recollection of events leading up to the accident and any retrograde amnesia is either absent or may be a matter of seconds. Whilst antrograde amnesia is difficult to quantify, if it is present it may be a matter of minutes.

All of this raises the fact that the collapse may have been synocopal. After the accident I was found to have a visual field defect in the lower nasal region of the right eye due to traumatic optic neuropathy.

I know its a bit of a generic question, but it could also be possible that this AVM may be related to the injury?? What are your thoughts?

Thanks. Great to be receiving some informative and insightful responses :)

[laphroaig]

I have had the pleasure of having one of these little :mad: in my brain. Fortunately I was lucky in that the neurosurgeons were able to completely remove it. I am now playing the waiting game with regards to getting the class 1 back. The trouble is that so few of the population, let alone flight crew, will ever suffer from these during thier life, and that there is very little information for the AME's to base thier decision on. It's certainly a case by case scenario.
I am always on the look out for any further info, so if anyone out there can help, it would be greatly appreciated.

[Mac the Knife]

PM me by all means, but I'm a splastic splurgeon not a vascular surgeon (though I do do microvascular surgery), so don't expect much more info than I've already given you.

"...do you think there is anything I should be specifically discussing with the neurologist or vascular surgeon when I see him??"

No, I'd just let him/her get on with it.

Good luck

Mac