What is the best approach for treating a symptomatic AVM that does not respond to conservative management?

Embolization is often the favored approach for treating a symptomatic arteriovenous malformation (AVM) that does not respond to conservative management. This minimally invasive procedure involves intentionally blocking or occluding the blood vessels that supply the AVM, which can reduce its size, alleviate symptoms, and prevent complications related to increased blood flow.

By using embolic agents, the interventional radiologist can effectively reduce the pressure in the AVM and decrease the risk of hemorrhage. This makes embolization especially valuable in cases where it serves as a pre-operative measure or a definitive treatment for AVMs, leading to a more manageable condition for the patient.

This technique's success hinges on its ability to specifically target the AVM, which is crucial given the potential risks posed by more radical treatments. Immediate surgery, while effective in some cases, carries higher risks and may not always be necessary if embolization can achieve the desired results. Chemotherapy and radiation therapy are generally not primary interventions for AVMs, as they do not directly address the vascular nature of the malformation.