Skip to main content

Colonic Arteriovenous Malformations

  • Chapter
  • First Online:
Gastrointestinal Bleeding

Abstract

Arteriovenous malformations are degenerative vascular lesions of the gastrointestinal tract that result in lower gastrointestinal bleeding, especially in the elderly. Although self-limiting in most cases, symptomatic arteriovenous malformations can present with massive bleeding in 15 % of cases. This review discusses the clinical presentation, diagnostic workup, and management of colonic arteriovenous malformations.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Margolis A, Heinbecker P, Bernard H. Operative mesenteric angiography in the search for the site of bleeding in unexplained gastrointestinal hemorrhage. A preliminary report. Surgery. 1960;48:534–7.

    Google Scholar 

  2. McAllister KA, Grogg KM, Johnson DW, Gallione CJ, Baldwin MA, Jackson CE, et al. Endoglin, a TGF-beta binding protein of endothelial cells, is the gene for hereditary haemorrhagic telangiectasia type 1. Nat Genet. 1994;8(4):345–51.

    Article  CAS  PubMed  Google Scholar 

  3. Boley SJ, DiBiase A, Brandt LJ, Sammartano RJ. Lower intestinal bleeding in the elderly. Am J Surg. 1979;137(1):57–64.

    Article  CAS  PubMed  Google Scholar 

  4. Foutch PG, Rex DK, Lieberman DA. Prevalence and natural history of colonic angiodysplasia among healthy asymptomatic people. Am J Gastroenterol. 1995;90(4):564–7.

    CAS  PubMed  Google Scholar 

  5. Boley SJ, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S. On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology. 1977;72(4 Pt 1):650–60.

    CAS  PubMed  Google Scholar 

  6. Zuckerman GR, Cornette GL, Clouse RE, Harter HR. Upper gastrointestinal bleeding in patients with chronic renal failure. Ann Intern Med. 1985;102(5):588–92.

    Article  CAS  PubMed  Google Scholar 

  7. Alhumood SA, Devine DV, Lawson L, Nantel SH, Carter CJ. Idiopathic immune-mediated acquired von Willebrand’s disease in a patient with angiodysplasia: Demonstration of an unusual inhibitor causing a functional defect and rapid clearance of von Willebrand factor. Am J Hematol. 1999;60(2):151–7.

    Article  CAS  PubMed  Google Scholar 

  8. Duray PH, Marcal JM, Livolsi VA, Fisher R, Scholhamer C, Brand MH. Gastrointestinal angiodysplasia: a possible component of von Willebrand’s disease. Hum Pathol. 1984;15(6):539–44.

    Article  CAS  PubMed  Google Scholar 

  9. Cody MC, O’Donovan TPB, Hughes Jr RW. Idiopathic gastrointestinal bleeding and aortic stenosis. Am J Dig Dis. 1974;19(5):393–8.

    Article  CAS  PubMed  Google Scholar 

  10. King RM, Pluth JR, Giuliani ER. The association of unexplained gastrointestinal bleeding with calcific aortic stenosis. Ann Thorac Surg. 1987;44(5):514–6.

    Article  CAS  PubMed  Google Scholar 

  11. Methodologic A. Aortic stenosis, idiopathic gastrointestinal bleeding, and angiodysplasia: is there an association? Gastroenterology. 1988;95:1670–6.

    Article  Google Scholar 

  12. Elmunzer BJ, Padhya KT, Lewis JJ, Rangnekar AS, Saini SD, Eswaran SL, et al. Endoscopic findings and clinical outcomes in ventricular assist device recipients with gastrointestinal bleeding. Dig Dis Sci. 2011;56(11):3241–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kushnir VM, Sharma S, Ewald GA, Seccombe J, Novak E, Wang I-W, et al. Evaluation of GI bleeding after implantation of left ventricular assist device. Gastrointest Endosc. 2012;75(5):973–9.

    Article  PubMed  Google Scholar 

  14. Demirozu ZT, Radovancevic R, Hochman LF, Gregoric ID, Letsou GV, Kar B, et al. Arteriovenous malformation and gastrointestinal bleeding in patients with the HeartMate II left ventricular assist device. J Heart Lung Transplant. 2011;30(8):849–53.

    PubMed  Google Scholar 

  15. Höchter W, Weingart J, Kühner W, Frimberger E, Ottenjann R. Angiodysplasia in the colon and rectum. Endoscopic morphology, localisation and frequency. Endoscopy. 1985;17(5):182–5.

    Article  PubMed  Google Scholar 

  16. Meyer CT, Troncale FJ, Galloway S, Sheahan DG. Arteriovenous malformations of the bowel: an analysis of 22 cases and a review of the literature. Medicine. 1981;60(1):36–48.

    Article  CAS  PubMed  Google Scholar 

  17. Moreto M, Figa M, Ojembarrena E, Zaballa M. Vascular malformations of the stomach and duodenum: an endoscopic classification. Endoscopy. 1986;18(6):227–9.

    Article  CAS  PubMed  Google Scholar 

  18. Clouse RE, Costigan DJ, Mills BA, Zuckerman GR. Angiodysplasia as a cause of upper gastrointestinal bleeding. Arch Intern Med. 1985;145(3):458–61.

    Article  CAS  PubMed  Google Scholar 

  19. Steger A, Galland R, Hemingway A, Wood C, Spencer J. Gastrointestinal haemorrhage from a second source in patients with colonic angiodysplasia. Br J Surg. 1987;74(8):726–7.

    Article  CAS  PubMed  Google Scholar 

  20. Cappell MS. Spatial clustering of simultaneous nonhereditary gastrointestinal angiodysplasia. Dig Dis Sci. 1992;37(7):1072–7.

    Article  CAS  PubMed  Google Scholar 

  21. Reinus JF, Brandt L. Vascular ectasias and diverticulosis. Common causes of lower intestinal bleeding. Gastroenterol Clin North Am. 1994;23(1):1–20.

    CAS  PubMed  Google Scholar 

  22. Ng DA, Opelka FG, Beck DE, Milburn JM, Witherspoon LR, Hicks TC, et al. Predictive value of technetium Tc 99m-labeled red blood cell scintigraphy for positive angiogram in massive lower gastrointestinal hemorrhage. Dis Colon Rectum. 1997;40(4):471–7.

    Article  CAS  PubMed  Google Scholar 

  23. Junquera F, Quiroga S, Saperas E, Pérez-Lafuente M, Videla S, Alvarez-Castells A, et al. Accuracy of helical computed tomographic angiography for the diagnosis of colonic angiodysplasia. Gastroenterology. 2000;119(2):293–9.

    Article  CAS  PubMed  Google Scholar 

  24. Richter J, Hedberg S, Athanasoulis C, Schapiro R. Angiodysplasia. Clinical presentation and colonoscopic diagnosis. Dig Dis Sci. 1984;29(6):481–5.

    Article  CAS  PubMed  Google Scholar 

  25. Skibba RM, Hartong WA, Mantz FA, Hinthorn DR, Rhodes JB. Angiodysplasia of the cecum: colonoscopic diagnosis. Gastrointest Endosc. 1976;22(3):177–9.

    Article  CAS  PubMed  Google Scholar 

  26. Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med. 2000;342(2):78–82.

    Article  CAS  PubMed  Google Scholar 

  27. Kok K, Kum C, Goh P. Colonoscopic evaluation of severe hematochezia in an Oriental population. Endoscopy. 1998;30(8):675–80.

    Article  CAS  PubMed  Google Scholar 

  28. Angtuaco TL, Reddy SK, Drapkin S, Harrell LE, Howden CW. The utility of urgent colonoscopy in the evaluation of acute lower gastrointestinal tract bleeding: a 2-year experience from a single center. Am J Gastroenterol. 2001;96(6):1782–5.

    Article  CAS  PubMed  Google Scholar 

  29. Green BT, Rockey DC, Portwood G, Tarnasky PR, Guarisco S, Branch MS, et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol. 2005;100(11):2395–402.

    Article  PubMed  Google Scholar 

  30. Gordon FH, Watkinson A, Hodgson H. Vascular malformations of the gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2001;15(1):41–58.

    Article  CAS  PubMed  Google Scholar 

  31. Bemvenuti G, Jülich M. Ethanolamine injection for sclerotherapy of angiodysplasia of the colon. Endoscopy. 1998;30(6):564–9.

    Article  CAS  PubMed  Google Scholar 

  32. Suzuki N, Arebi N, Saunders BP. A novel method of treating colonic angiodysplasia. Gastrointest Endosc. 2006;64(3):424–7.

    Article  PubMed  Google Scholar 

  33. Gostout CJ, Bowyer BA, Ahlquist DA, Viggiano TR, Balm RK, editors. Mucosal vascular malformations of the gastrointestinal tract: clinical observations and results of endoscopic neodymium: yttrium-aluminum-garnet laser therapy. Mayo Clinic Proceedings; 1988: Elsevier.

    Google Scholar 

  34. Nicholson A, Ettles D, Hartley J, Curzon I, Lee P, Duthie G, et al. Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage. Gut. 1998;43(1):79–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Rose SC, Dunnick NR. Angiographic treatment of gastrointestinal hemorrhage: comparison of vasopressin infusion and embolization. Invest Radiol. 1987;22(4):354–6.

    Article  CAS  PubMed  Google Scholar 

  36. Bokhari M, Vernava AM, Ure T, Longo WE. Diverticular hemorrhage in the elderly—is it well tolerated? Dis Colon Rectum. 1996;39(2):191–5.

    Article  CAS  PubMed  Google Scholar 

  37. McGuire Jr HH. Bleeding colonic diverticula. A reappraisal of natural history and management. Ann Surg. 1994;220(5):653–6.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg. 1986;204(5):530–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Zuckerman GR, Prakash C. Acute lower intestinal bleeding: part I: clinical presentation and diagnosis. Gastrointest Endosc. 1998;48(6):606–17.

    Article  CAS  PubMed  Google Scholar 

  40. Farner R, Lichliter W, Kuhn J, Fisher T. Total colectomy versus limited colonic resection for acute lower gastrointestinal bleeding. Am J Surg. 1999;178(6):587–90.

    Article  CAS  PubMed  Google Scholar 

Download references

Financial Disclosures

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher R. Mantyh M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing AG

About this chapter

Cite this chapter

Sun, Z., Adam, M.A., Mantyh, C.R. (2016). Colonic Arteriovenous Malformations. In: Pryor, A., Pappas, T., Branch, M. (eds) Gastrointestinal Bleeding. Springer, Cham. https://doi.org/10.1007/978-3-319-40646-6_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-40646-6_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-40644-2

  • Online ISBN: 978-3-319-40646-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics