5SanduAurelia_Experimental


 

 

 

 

 
166          Sandu et al          Experimental model of arteriovenous malformation 

 

 

 

 

 

 

 

Experimental model of arteriovenous malformation in 

vitro using biological grafts 

Aurelia Mihaela Sandu1,2, A. Giovani1,2, M.R. Gorgan2,3 

1PhD student, University of Medicine and Pharmacy “Carol Davila”, Bucharest 
2Fourth Department of Neurosurgery, Emergency Clinical Hospital Bagdasar Arseni, Bucharest 
3University of Medicine and Pharmacy “Carol Davila”, Bucharest 

 
Abstract: Introduction: Brain arteriovenous malformations (AVMs) represent a serious 

health problem all around the world. Experimental models help to better understand the 

pathophysiology of these lesions. Experiment: We performed an experimental model of 

AVM using biological grafts, arteries and veins harvested from chicken wings at the 

elbow joint. We used 14 vessels and we performed 20 end-to-end anastomoses to create 

a nidus with a single feeding artery and a single draining vein. The system was irrigated 

with colored solution. The experiment was done according with law in force regarding 

experimental research activity. Conclusions: Experimental models allow us to 

understand the hemodynamics and predict the outcome of brain AVMs in humans. This 

experimental model is a useful tool in understanding the hemodynamic properties of 

brain AVMs. It is very useful in vascular anastomosis training.  

Key words: arteriovenous malformations, biologic grafts, chicken wings, experimental 

model 

 
Introduction 

Vascular malformations of the brain 

represent a serious health problem.(8;29) 

Brain arteriovenous malformations (AVMs) 

are not very frequently encountered, having an 

incidence of 0.89-1.34 cases/100.000 

inhabitants/year (3;4;20) and a prevalence of 

0.02-0.2% (1;2;20;31;34). Although they are no 

common pathology, brain AVMs represent a 

continuous and prolific field of research (8-

10;27-29), because social impact of this disease 

is high. They become clinically manifest in 

young and active people, mean age at 

diagnosis varying from 29 to 33 years.(25;29) 

Brain AVMs carry high morbidity and 

mortality. They are the most common cause of 

spontaneous hemorrhagic stroke in young 

people.(7;11) Hemorrhagic stroke has 

devastating consequences, being a major cause 

of mortality, morbidity and long-term 

neurological deficits. Thus, after AVMs 

rupture with intraparenchymatal hemorrhage, 

mortality reaches 10% and morbidity accounts 

for 30-50%.(11;14;16) Other clinic forms 



 

 

 

 

 
Romanian Neurosurgery (2015) XXIX 2: 166 - 171           167 

 

 

 

 

 

 

 

specific to brain AVMs are with seizures and 

neurological deficits.  

Brain AVMs are composed by a network of 

dysplastic vessels (dilated arteries, arterialized 

veins, interconnected through shunts), from 

which arterial blood flows from arteries 

directly into draining veins, without any 

capillary bed.(11;21;32;35) AVMs have 

complex hemodynamic effects, impairing 

normal brain blood flow. 

The aim of this article is to make an 

experimental in vitro model of brain AVM, 

using biological grafts. 

Experiment 

We used vessels (arteries and veins) 

harvested from chicken wings, at the elbow 

joint. Short chicken wing anatomy is 

summarized below. Surprisingly, chicken wing 

anatomy resembles human upper limb 

anatomy. Bones are represented by humerus, 

radius, ulna, carpal bones, metacarpals, alula 

and phalanges. Muscles of the arm are biceps 

and triceps and of the forearm are radialis 

longus and ulnaris muscles. At the elbow joint 

humeral artery bifurcates into radial and ulnar 

arteries. Radial and ulnar veins join into 

brachial vein. 

We harvested 14 vessels (arteries and 

veins) from the elbow joint, at the point where 

they bifurcate. So all vessels were “Y” shaped. 

After harvesting, vessels were kept in a normal 

saline solution. We performed 20 end-to-end 

anastomoses, under operating microscope, 

using microsurgical instruments, according to 

the scheme shown in figure 1. Anastomoses 

were done according to the classical principals 

of vascular surgery. Two sutures were placed 

on the lateral sides, joining the two vascular 

ends together. The posterior wall of the 

anastomosis was sewed first, using a prolene 

11-0 continuous suture, followed by suturing 

of the anterior wall in the same fashion.  

This model mimics an AVM nidus with a 

single feeding artery and single draining vein. 

The afferent artery was catheterized using an 

intravenous cannula and the system was 

irrigated with colored solution (normal saline 

and blue ink) in a pulsatile fashion.   

The experiment was done according with 

law in force regarding experimental research 

activity. 

 

 
Figure 1 - Schematic view of the experimental model 

of AVM 

 

 
Figure 2 -  Part of experimental model of AVM 



 

 

 

 

 
168          Sandu et al          Experimental model of arteriovenous malformation 

 

 

 

 

 

 

 

 
Figure 3 - Final view of the experimental model of 

AVM 

 

 
 

 
Figure 3 - Experimental model of AVM irrigated 

with colored solution, by catheterizing the afferent 

vessel with an intravenous cannule 

Disscusions 

Over the time, researchers from the field of 

medicine, tried to build experimental models 

of brain AVMs.(5;6) Experimental models can 

be true or virtual. True experimental models 

can be built in vitro or in vivo. Grafts used to 

recreate the network of a brain AVM can be 

synthetic (Dacron or Goretex) or biological.  

True in vivo models were done in 

experimental animals. Massoud et al 

performed an experimental AVM in swine, 

using a side-to-side carotid-jugular 

anastomosis and ipsilateral endovascular 

occlusion of occipital artery, external carotid 

artery and muscular branch of the ascending 

pharyngeal in the pig’s neck, with subsequent 

forming of a rete mirabilis, mimicking a nidus, 

with feeding artery and draining veins.(22-24) 

Qian et al. performed an in vivo 

experimental AVM model in sheep, making a 

side-to-side carotid-jugular anastomosis, 

jugular vein ligation above the arteriovenous 

fistula and ligation of common carotid artery 

proximal to the anastomosis.(26) 

Schumacher et al. designed an 

experimental model in dogs, performing a 

bilateral high-flow carotid to external jugular 

vein fistula, which was later occluded with a 

coated stent on one side, whereas the 

contralateral side remained patent.(30) 

Other experimental models in animals 

were performed in rats. Herman et al. 

performed an anastomosis between common 

carotid artery and external jugular vein, 

accompanied by occlusion of the sagittal sinus 

and of the vein draining the transverse 

sinus.(15) 



 

 

 

 

 
Romanian Neurosurgery (2015) XXIX 2: 166 - 171           169 

 

 

 

 

 

 

 

Experimental models were used not only to 

design an anatomical network of vessels with 

specific hemodynamic properties, but also to 

explain consequences secondary to associated 

AVMs, such as normal perfusion pressure 

breakthrough.(12) 

Animals models proved to be faithful copy 

of brain AVMs.(33) Animal models of AVMs 

can be used to apply several therapies, such as 

radiosurgery ot endovascular embolization.(6)   

Also virtual models of brain AVMs were 

designed for research purposes. Computer and 

biomathematical models were used to imitate 

a brain AVM and its consequences.(13;36) 

Computer and biomathematical experimental 

models are a theoretical method of 

investigating AVM. Hademenos et al. 

constructed an electrical networks based on 

the biomathematical AVM model, in order to 

provide an accurate rendering of transnidal 

and intranidal hemodynamics.(13) Computer 

models are useful for pathophysiological 

studies. The advantage of these models is the 

flexibility, which cannot be found in an intact 

system.(36) The disadvantage is that they are 

dependent on the assumptions made by their 

constructors.(36) 

Kerber et al. performed an experimental 

model of brain AVM using an open pore 

cellulose sponge and a wax wire, 4.5-6.5 in 

diameter, simulating single draining vein and 

one to three wax wires, 2.6 mm in diameter, 

simulating feeding arteries, attached to the 

sponge with adhesive elastomer.(18)  

Inagawa et al. created an artificial nidus 

model, using one milliliter syringe, in which 

they put small beads, 2.5x4.5 mm in size, 

which was connected through tubes to a active, 

pulsatile flow circuit.(17) 

Human placenta was used as an ex vivo 

vascular model in research because its vessels 

resemble brain AVM.(19)  

Conclusions 

Experimental models allow us to 

understand the hemodynamics and predict the 

outcome of brain AVMs in humans. This 

experimental model is a useful tool in 

understanding the hemodynamic properties of 

brain AVMs. It is very useful in vascular 

anastomosis training. 

 

Acknowledgement 

This paper was co-financed from the 

European Social Fund, through the Sectorial 

Operational Programme Human Resources 

Development 2007-2013, project number 

POSDRU/159/1.5/S/138907 “Excellence in 

scientific interdisciplinary research, doctoral 

and postdoctoral, in the economic, social and 

medical fields - EXCELIS”, coordinator The 

Bucharest University of Economic Studies. 

 

Correspondence 

Aurelia Mihaela Sandu, address: Emergency 

Clinical Hospital Bagdasar-Arseni, No. 10-12, 

Berceni Street, Sector 4, Bucharest; e-mail: 

aurasandu@gmail.com; tel. 0724.263.023 

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