Embolization of Arteriovenous Malformations (AVM) or Dural Arteriovenous Fistula (DAVF) of the Brain and Spine

General Information | Scheduling, Insurance and Preparation | What to Expect


General information General Information

About Endovascular Embolization of AVMs and DAVFs

A type of blocking material (microspheres, coils, or liquid glue) is used to fill the abnormal blood vessels in the AVM.

Embolization is a minimally-invasive technique for blocking the abnormal vessels in an arteriovenous malformation or dural fistula. It is usually done in an attempt to eliminate or reduce the risks of hemorrhage associated with either an AVM or DAVF.

With AVM or DAVF embolization, an interventional neuroradiologist guides a long tube called a catheter through a small incision in the groin up to the location of the AVM or DAVF. Through the catheter, the radiologist injects various materials, called embolic agents, into the abnormal blood vessels to reduce blood flow or completely block them.

Embolization, Surgery, and Stereotactic Radiosurgery

The interventional neuroradiologist will determine the best treatment(s) to use and the number of treatments needed based on your medical history, symptoms, and the size and location of the AVM or DAVF. Treatment may require any combination of stereotactic radiosurgery (a single high dose of targeted radiation), embolization, and surgical removal. The extent of treatment is usually judged by the complexity of the AVM or DAVF and is often "staged" if more than one treatment session is anticipated.

Embolization may be the only treatment required. Newer embolic agents are increasing the cure rate of embolization alone.

Risks Involved in an Endovascular Embolization

Patients who are deemed suitable for embolization of an AVM or DAVF will undergo a thorough consultation with an interventional neuroradiologist. A detailed explanation of the procedure and risks will be provided during the consultation.

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Scheduling, Insurance and Preparation Scheduling, Insurance and Preparation

Procedure Locations

Consultations for preventative endovascular embolizations are done at RIA Neurovascular.

The procedure is performed at the following Radiology Imaging Associates partner hospitals in the Denver, Colorado area:

  • Exempla Lutheran Hospital
  • Littleton Adventist Hospital
  • Medical Center of Aurora
  • Swedish Medical Center
Call 720-493-3345 to schedule a consultation.

Scheduling

To schedule a consultation to discuss AVM embolization or DAVF embolization, call 720-493-3345.

Insurance Coverage

AVM embolization and DAVF embolization are usually covered by insurance. If the procedure is done as a preventive measure, check with your insurance company to be sure. Please bring your insurance card with you to your consultation.

Conditions to Let Us Know About

When you have your consultation for an endovascular embolization, let the radiologist or nurse know if any of the following circumstances apply to you:

  • Currently pregnant or nursing
  • Previous reaction to iodine or contrast material
  • Renal disease
  • Asthma with inhaler use 2 times or more per day
  • Diabetic

Preparation Guidelines

If you are a candidate for preventative endovascular embolization, you will be given detailed preparation guidelines. Following are some of the basic guidelines; however, you may receive additional or differing guidelines based on your specific situation. Please contact us at 720-493-3406 if you have any questions.

  • Do not eat or drink anything but clear liquids for 8 hours before the procedure; do not drink anything for 4 hours before the procedure.
  • Prepare for an overnight stay in the hospital.
  • Arrange for someone to drive you home from the procedure.

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What to Expect What to Expect

Before the Procedure

If you appear to be a candidate for preventative embolization of an AVM or DAVF, you will undergo various exams prior to the procedure. These are necessary for the radiologist to confirm the diagnosis and help plan for treatment.

During the Procedure

A fluoroscope allows the radiologist to see the catheter within the blood vessels and carefully guide it to an artery that feeds the nidus of the AVM.

Here is generally what will happen during an AVM or DAVF embolization procedure:

  1. You will change into a gown.
  2. A technologist will answer your questions then start an intravenous (IV) line in your arm. He or she will set up various devices so your heart rate and blood pressure can be monitored throughout the procedure.
  3. An anesthesiologist will administer general anesthesia and you will sleep during the procedure.
  4. The site of the groin incision will be cleansed.
  5. A fluoroscope will be moved into position above the abdomen.
  6. The groin incision will be made and the catheter will be inserted into the femoral artery. Using the fluoroscope images, the radiologist will carefully guide the catheter to the location of the AVM or DAVF.
  7. One or more embolic agents will be pushed through the catheter into the blood vessels that supply the AVM or DAVF.
  8. The catheter will be withdrawn and the incision cleaned and taped.

The procedure may take several hours to complete, Patients are observed in the Intensive Care Unit following their embolization. Recovery time is minimal for most patients. They are often discharged the following day unless more than one embolization is planned during their hospitalization.

After the Procedure

Recovery

Most patients feel fine after the procedure. Some patients experience minor side effects such as headaches.

Follow-Up

It is very important that you go to all follow-up appointments requested by your treating physician. Follow up angiograms will likely be necessary regardless if the AVM or DAVF was treated with embolization alone, or required additional treatment such as surgery or stereotactic radiosurgery. These will be specific to each patient, and will be determined by the team of treating physicians.

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