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home - Miscellaneous - Vascular Lesions - Angiodysplasias Written by Dr Sebastian Zeki

Angiodysplasias

Angiodysplasia (= vascular ectasia/ AV malformation) Composed of ectatic, dilated, thin-walled vessels (usually veins)Lined by endothelium alone or by only small amounts of smooth muscle. Small AV communica-tions are present due to incompetence of the precapillary sphincter Enlarged arteries are also present in bigger angiodyspla-sias and is associated with AV fistulas Pathogenesis-Chronic low grade venous obstruction.-Chronic mucosal ischemia from straining.-Local ischemia in arteriopath.-Congenital. Pathology Epidemiology and Natural HistoryColonic is the most common (usually right sided).Age at diagnosis is in >60's.Prevalence: > 1 angiodysplasia in 50 %.80% are clustered in one region. Associations:End-stage renal disease.Von Willebrand's disease.Aortic stenosis — Possibly due to acquired von Willebrand Disease. DiagnosisIt is seen at endoscopy as a 5 to 10 mm cherry red, fern-like pattern of arborizing, ectatic blood vessels radiating from a central vessel Treatments:Electrocoagulation.Sclerotherapy.Band ligation —for the stomach.Lasers —Argon and Nd-YAG lasers.Angiography —Reserved for life-threatening bleeds in poor surgical candidates.Surgery —Can recur post-surgery.Hormonal therapy —Useful in Osler-Weber-Rendu syndrome, von Willebrand disease, and ESRF. Four proposed aetiologies: Bleeding improves after aortic valve replacement (AVR). Written by Dr Sebastian Zeki

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