If you have an AVF, your doctor may have recommended arteriovenous fistula repair to prevent further health complications. The treatment that he or she recommends will depend upon the circumstances of your arteriovenous fistula and your health history, but it will generally be one of two types of surgery: catheter embolization or microsurgical resection.
The treatment goal of both procedures is generally the same: Stop blood from flowing through the arteriovenous fistula, which is a malformation of the circulatory system. Normally, blood rich with oxygen travels through blood vessels called arteries, which deliver oxygen to tissues at a bed of capillary vessels. The capillaries then connect to the venous system, which returns the oxygen-poor blood to the heart and lungs.
In patients with an arteriovenous fistula, the arterial system connects directly to the venous system, bypassing the capillary beds completely. As a result, oxygen does not get delivered to the affected tissues, and the pressure in the veins is much higher than it should be. This can lead to dangerous rupture and bleeding, or other symptoms, particularly if the arteriovenous fistula is near the brain or spinal cord.
These potential complications are why your doctor has recommended you undergo arteriovenous fistula repair. Both types of AVF surgery for repair are effective, but what options are available depend upon the location and severity of your arteriovenous fistula, other health conditions you may have and a range of other factors that have led your neurosurgeon to recommend one treatment over another.
About Catheter Embolization
One treatment option is called catheter embolization. The neurosurgeon makes an incision near the groin, in the upper inner thigh, to access an artery, then inserts a catheter. He will use an imaging-guided system to direct the catheter to the site of the arteriovenous fistula. Then he will inject a material called an embolic agent, which essentially stops up the blood vessel and blocks the blood from flowing through the malformed area. The embolic agent might be a glue-like material or something called Onyx.During this procedure for arteriovenous fistula repair, you will usually be under general anesthesia to maximize your comfort and allow the neurosurgeon to perform the surgery.
Recovering From Catheter Embolization
Your recovery from a catheter embolization begins in the hospital, where you can expect to stay for a day or two after the procedure. Right after the procedure, you may be asked to lie flat for about six hours, but after that you may sit up and walk if you feel ready. During this time, your healthcare team will be monitoring your incision for bleeding or swelling and checking for any complications from the embolization procedure itself.
Recovering at home can take anywhere from a few days to a few weeks, depending on your overall health and other factors. In the early days of your recovery, activities like driving, exercise and heavy lifting will be restricted, and it’s important to get plenty of rest. Your doctors may prescribe medications for pain and other issues. You will need to check the incision site at your inner thigh for signs of infection and bleeding, although this incision site typically is without complication.
You can gradually resume normal activities over the next week or so.In the weeks after catheter embolization, you can expect to see your doctors for a follow-up to check the healing of your incision and the outcome of the procedure. Some people also needed multiple embolization procedures spread over time, something called staged embolization.
This procedure is considered minimally invasive and is a means for the neurosurgeon to indirectly access the arteriovenous fistula. However, it is not appropriate for all patients, as some arteriovenous fistulas cannot be closed up using an embolic agent.
About Microsurgical Resection
Some patients are not good candidates for catheter embolization, so your physician may recommend a different procedure for arteriovenous fistula repair, called microsurgical resection. Microsurgery is surgery done under a special microscope, which allows the surgeon to have greater visibility while performing delicate procedures. Because of this cutting-edge technology, cerebrovascular neurosurgeons can perform surgeries that were previously too difficult, or even impossible, to undertake.
During this procedure, your neurosurgeon will directly access your arteriovenous fistula to repair it. The neurosurgeon will need to perform a craniotomy in order to access the blood vessels. This means that they will remove a small section of the skull, providing them with direct access to the site of malformation.
However, not all patients will need to undergo a craniotomy, depending upon the location and circumstances. Not all atrioventricular fistulas occur around the brain, and even some that do can be accessed through incisions at other sites. Like catheter embolization, microsurgical resection requires you to be under general anesthesia.
Recovering From Microsurgical Resection
Your recovery from microsurgery to remove an AVF depends on many factors, including your age, health, and the location and size of the fistula. Generally, though, you can expect to spend about three to five days in the hospital while your care team monitors your recovery from anesthesia and the healing of your incision and checks for any complications from the procedure.
Recovering at home can take several weeks, usually six weeks, but your recovery will vary due to your health and circumstances, as all patients are different.Your doctors will provide specific instructions on caring for your incision after you go home. You can expect to have restrictions on driving, lifting and strenuous activities for a week or so, with a gradual return to normal activities over the next few weeks.
During this time, you may feel fatigued and have some pain, so your doctors may prescribe medications to help your recovery. If your surgery involved the brain, you may have temporary neurological problems, such as difficulty concentrating or problems with coordination or balance. In the weeks after surgery, you can expect to see your doctors for follow-ups to remove stitches and check the progress of your healing. You can expect to be back to work after six weeks.
Risks of AVF Treatments
Treatments for an AVF are generally safe, but both catheter embolization and microsurgical resection have risks.
Catheter Embolization
Catheter embolization is minimally invasive and requires just a small incision in an artery, usually the femoral artery in the groin, but that can bring risks of bleeding, swelling and bruising at the incision site, as well as a risk of infection.The catheter can also damage blood vessels.
Other risks include allergic reactions to the contrast dyes used in imaging to locate the fistula or reactions to anesthetics, anesthesia, or rarely other drugs that you maybe administered. In some cases, stroke or seizure can happen.
Microsurgical Resection
Risks of microsurgery to repair a fistula depend partly on the location of the fistula. Removing an AVF in the brain raises risks of stroke, as well as of seizures or permanent neurological problems with functions like memory and coordination.
Other risks include bleeding, swelling or infection at incision sites, as well as blood clots and damage to blood vessels and nerves affected by the surgery.
Risks can also include allergic reactions to anesthesia, or to medications related to the procedure. Your doctors will work with you and your unique circumstances to minimize risks and work toward a smooth recovery from your AVF procedure.
The Right Treatment for You
Your cerebrovascular specialist will recommend the treatment that he feels has the best potential outcome for you, based upon your personal circumstances and health history. For some patients, catheter embolization is not an option because the neurosurgeon is unable to close the arteriovenous fistula that way. For other patients, catheterization embolization may be a better solution because of its less invasive nature, or because the catheter can reach deeper into the brain than what would be considered safe during open brain surgery.
Regardless, be sure to take the time to discuss your treatment options with your surgeon and raise any questions or concerns you may have before the procedure. Their goal is to provide you with optimum care, which includes making sure you are comfortable before, during and after your arteriovenous fistula repair surgery. They are best able to do that if they know exactly what your concerns are, and will then be able to help address them, ensuring you have the best experience possible.
