Rate of re-bleeding of arteriovenous malformations in the first year after rupture

J Clin Neurosci. 2012 Aug;19(8):1087-8. doi: 10.1016/j.jocn.2011.12.005. Epub 2012 Jun 15.


Prior rupture is an established risk factor for subsequent hemorrhage from arteriovenous malformations (AVM). Recent natural history studies have reinvigorated the important concept that the re-bleed rate is not constant; rather, it is particularly greater in the first year after hemorrhage. In this study, we reviewed our own cohort of 129 patients with AVMs. Eighty-one presented with hemorrhage (63%), and of these patients, 38 had at least one month of subsequent clinical follow-up and were included in our analysis. Over a total of 140 patient-years, the annual re-hemorrhage rate was 7.9%, though it was 15.8% in the first year. Two-thirds of those AVM that hemorrhaged in the first year were associated with aneurysms. The overall permanent morbidity of re-hemorrhage was 45%; the mortality rate was 9%. Although the re-hemorrhage rate in the first year varied from 6% to 15.8% across series in the literature, it was generally double the overall re-hemorrhage rate provided in each study. These results have significant therapeutic implications, favoring surgical treatment of ruptured AVM and/or their associated aneurysm when feasible to avoid the incumbent greater risk of early rehemorrhage.

MeSH terms

  • Adult
  • Arteriovenous Malformations / complications*
  • Arteriovenous Malformations / epidemiology
  • Cohort Studies
  • Female
  • Hemorrhage / epidemiology
  • Hemorrhage / etiology*
  • Humans
  • Male
  • Retrospective Studies