If your doctor has diagnosed you with an arteriovenous fistula, chances are he or she has recommended surgery to correct the issue before complications arise. An AV fistula is a malformation of the blood vessels, and it may develop spontaneously or following a traumatic event.
The circulatory system transports two types of blood through the body: oxygen-rich blood, which travels to the tissues, and oxygen-poor blood, which returns from the tissues. The two branches of the system connect via a small network of blood vessels at a capillary bed. Blood rich with oxygen travels through the arterial system, passes through the capillaries and drops off the oxygen and then returns through the venous system to receive more oxygen.
In patients with an AV fistula, the blood vessels of the arterial and venous system are connected directly, rather than via the capillary bed. This can result in oxygen deprivation at the tissues as well as increased pressure in the venous system. If the AV fistula is near the brain or spinal cord, this can have dangerous consequences. This is why your physician has recommended treatment.
There are two main surgical treatment approaches: catheter embolization and microsurgical resection. Each is an effective treatment, and what your physician recommends will depend upon the circumstances of your case. However, being knowledgeable about your condition and potential treatments will help you discuss your options with your doctor, allowing you to make informed decisions.
Catheter Embolization
Catheter embolization is a minimally invasive procedure that only requires a single incision. Your cerebrovascular neurosurgeon will insert a catheter into an artery of your upper inner thigh, then guide the catheter to the site of the AV fistula using radiation and dye injections.
Once the catheter reaches the area, your surgeon will inject what is known as an embolic substance. This could be something called NBCA or Onyx, glue-like materials that block off the AV fistula and prevent further blood from flowing through the area, preventing future ruptures and reducing pressure through the system.
When wondering, “How long does AV fistula surgery take?”, this procedure is the shorter of the two. The procedure itself will take a number of hours, depending upon the circumstances of your case and the embolic substance used. Typically, the length of the catheter embolization is limited by the amount of radiation and contrast dye that can be used safely in one sitting. Similarly, recovery time can vary, but in general, you can expect to spend approximately 48 hours in the hospital. During that time, you may be required to stay in a lying down position for around six hours. The rest of your hospital stay allows your care team to observe you and the results of the surgery before releasing you to go home.
Because of the minimally invasive nature of catheter embolization, your recovery from the surgery itself is simply healing at the incision site, which is usually complete within a couple of weeks, depending on your health status and the particulars of your condition.
Microsurgical Resection
Microsurgical resection is sometimes necessary for patients if catheter embolization does not work or is not possible. Microsurgery is done using a surgical microscope, allowing your neurosurgeon to operate on small, delicate structures with greater visibility.
Microsurgical resection is more invasive than catheter embolization because your surgeon must directly access the AV fistula and repair it, rather than blocking it off indirectly. If your AV fistula is in the brain, then your microsurgical resection will require a craniotomy, or removal of a section of the skull, for direct access.
You will require general anesthesia (unconsciousness) for catheter embolization and microsurgical resection. Your surgeon will discuss your individual case with you, and if you have any questions about anesthesia, be sure to ask. Being informed will help reduce the stress of your upcoming procedure and will give you a better idea of how long your AV fistula surgery will take.
Because of the nature of the surgery, microsurgical resection will typically take a little longer, and recovery time in the hospital could range from three to seven days, depending upon your circumstances. However, if your surgeon recommends microsurgical resection for your AV fistula, it is because that is the treatment she feels would be most beneficial, regardless of a longer recovery time.
Making the Decision
When your doctor recommended surgical treatment for your AV fistula, one of your first questions might have been, “How long does AV fistula surgery take?” Hopefully, after reading the information provided here, you can see that while recovery time is important to know about and understand, it is not a key factor to consider when deciding between treatment options.
Regardless of which treatment you will be undergoing, you will be spending at least a couple of days in the hospital, and you will have a recovery period at home, during which time your activities will be restricted in some way. It may be slightly longer because of the particular procedure or simply because of your personal circumstances.
Every patient is different, and your neurosurgeon will be able to recommend the surgery for you that he thinks is best. If you have questions about why he recommends one method over another, you can always ask. If you have any concerns, it’s best to express them before the surgery so your doctor can help you better understand and be comfortable with the procedure you are about to experience.
