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Original research
Cerebral arteriovenous malformation draining vein stenosis is associated with atherosclerotic risk factors
  1. Nasya Mendoza-Elias,
  2. Sophia F Shakur,
  3. Fady T Charbel,
  4. Ali Alaraj
  1. Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
  1. Correspondence to Dr Ali Alaraj, Department of Neurosurgery, University of Illinois, MC-799 Chicago, Illinois 60612, USA; alaraj{at}


Objective The pathogenesis of venous outflow stenosis associated with cerebral arteriovenous malformation (AVM) draining veins is poorly understood. We sought to determine the relationship between venous stenosis and atherosclerotic risk factors.

Materials and methods All patients with an AVM seen at our institution between 1990 and 2016 were retrospectively reviewed. Patients <18 years of age were excluded. Patients were classified into two groups based on the presence or absence of venous stenosis. Patient charts were reviewed for the following atherosclerotic risk factors: age >50 years, sex, race, hypertension, type 2 diabetes mellitus, hyperlipidemia, coronary artery disease, chronic kidney disease stage III, and cigarette smoking. The relationship between venous stenosis and atherosclerotic risk factors was assessed using univariate and multivariate analyses.

Results 278 patients were included (mean age 41 years, 55% men). Venous stenosis was present in 87 patients (31% of the cohort). The presence of venous stenosis was significantly associated with age >50 years (P=0.05), hypertension (P=0.05), diabetes (P=0.02), and hyperlipidemia (P=0.001). Multivariate analysis showed that hyperlipidemia (P=0.05) was predictive of draining vein stenosis.

Conclusions Venous stenosis is associated with several atherosclerotic risk factors, suggesting that cerebral AVM venous outflow stenosis occurs by a degenerative process. Additional studies can show whether these modifiable risk factors may be targeted to prevent draining vein stenosis and AVM rupture.

  • arteriovenous malformation
  • atherosclerosis
  • stenosis
  • blood pressure
  • Vein

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  • Contributors NM-E: drafted the manuscript, data collection, and statistical analysis. SS: drafted and revised the manuscript. FTC: reviewed the manuscript. AA: devised and supervised the project, and critically revised the manuscript.

  • Competing interests AA: research grant from NIH; consultant for Cordis-Codman. FTC: ownership interest in VasSol Inc; consultant for Transonic.

  • Ethics approval The study was approved by the institutional review board of the University of Illinois at Chicago.

  • Provenance and peer review Not commissioned; externally peer reviewed.