gms | German Medical Science

Objective: Estimation of the natural history of arteriovenous malformations based on short-term observation is potentially biased by multiple factors. Retrieval of demographic information of all AVM patients admitted to German hospitals and comparisons with the national demographic profile might be another way to define whether harboring an AVM is a life limiting condition.

Method: Upon request, the German Federal Statistical Office provided the numbers of patients admitted in Germany from 2009 through 2013 with ICD Q28.2 (brain AVM) as primary discharge diagnosis, and the corresponding age distribution. Age related incidence rates of AVM were calculated.

Results: A total of 6527 patients were hospitalized from 2009-2013 in Germany for brain AVMs. After the first year of life, age related incidence rates increased continuously up to the age group from 20 to 24 years, where it reached a plateau of approximately 11/100000. After the age of 35-39, incidence decreased with a nearly constant rate of about 1% per year up to the age group 65-69 years, and thereafter with a yearly rate of around 12%, reaching 0 in the age group 90-94 years. Assuming that loss of incidence corresponded to decreasing survival with AVM, life tables for AVM carriers were calculated for the overall annual risk of death or having the AVM eliminated in comparison to the normal population, and the cumulative chance of survival with AVM. Harboring an AVM was the dominant health risk up to the age of 86-89 years for men and women. Above that age AVM unrelated factors became the dominant health risks.

Conclusions: The current data suggest that achieving old age with an untreated brain AVM is unlikely. Furthermore the data support the concept that brain AVM is not necessarily a congenital entity but develops during the first decades of life.