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Embolization of Arteriovenous Malformation and Fistula in Brain

Last updated Jan. 18, 2019

Hellerhoff

MRA of the brain depicting AVM in R Parietal lobe.


Background Information:

What are the other Names for the Procedure?

  • Brain Arteriovenous Malformation Vascular Embolization
  • Brain Fistula Vascular Embolization
  • Embolization of Brain Arteriovenous Malformation and Fistula

What is Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure? (General Explanation)

  • An embolization is a minimally invasive procedure used to treat aneurysms and other blood vessel abnormalities in the brain
  • An abnormal connection between the arteries and veins in the brain is known as a brain arteriovenous malformation (AVM)
  • AVMs may stop oxygenated blood from circulating in the brain, which results in neuropathological symptoms, such as double vision, pain, glaucoma, or unusual sounds (heard in one ear)
  • The Embolization of Arteriovenous Malformation and Fistula in Brain involves using liquid embolic agents to fill the AVMs

What part of the Body does the Procedure involve?

The Embolization of Arteriovenous Malformation and Fistula procedure involves the brain and neck region.

Why is the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure Performed?

The Embolization of Arteriovenous Malformation and Fistula procedure is performed to treat arteriovenous malformations in the brain.

What is the Equipment used? (Description of Equipment)

The following equipment is used for an Embolization of Arteriovenous Malformation and Fistula procedure:

  • A catheter, through which a liquid embolic agent is injected into the AVM
  • Heart rate monitor
  • Blood monitor

What are the Recent Advances in the Procedure?

There have been no recent advances to replace the Embolization of Arteriovenous Malformation and Fistula in Brain procedure.

What is the Cost of performing the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure?

The cost of the Embolization of Arteriovenous Malformation and Fistula in Brain depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

If the patient experiences an allergic reaction to the anesthesia, then he/she should notify their physician immediately.

What are some Helpful Resources?

http://www.radiologyinfo.org/en/info.cfm?pg=cathembol (accessed on 07/20/2015)

Prior to Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure:

How does the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure work?

  • A catheter is inserted into the artery using an imaging technique and sent to the site of the arteriovenous malformation (AVM)
  • The catheter is placed at the abnormal connection between the artery and vein, as a liquid adhesive agent is injected. The liquid adhesive agent blocks the abnormal connection between the artery and vein

How is the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure Performed?

The Embolization of Arteriovenous Malformation and Fistula in Brain procedure is performed in the following manner:

  • A CT scan or MRI is performed before the embolization procedure
  • The patient’s heart rate, blood pressure, and pulse are monitored
  • An intravenous (IV) line is inserted into the patient’s arm and sedatives are given through IV lines
  • A catheter is inserted and sent to the site of the arteriovenous malformation
  • Liquid agents are then used to plug the abnormal connection
  • The catheter and IV lines are removed at the end of the procedure
  • If the AVM was leaking, then the patient is hospitalized for a few days

Where is the Procedure Performed?

An Embolization of Arteriovenous Malformation and Fistula in Brain procedure is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

An Embolization of Arteriovenous Malformation and Fistula procedure is performed by interventional radiologists and interventional neuroradiologists.

How long will the Procedure take?

The Embolization of Arteriovenous Malformation and Fistula in Brain procedure could take anywhere between 1-3 hours.

Who interprets the Result?

An interventional neuroradiologists interprets the results and informs the primary care physician to set up a follow-up care for the patient.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to an Embolization of Arteriovenous Malformation and Fistula in Brain procedure:

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
  • Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
  • Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
  • It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the x-ray
  • Women should notify the physician, if they are pregnant or breastfeeding their child; as many such procedures may not be performed on pregnant women
  • The patient may be asked to avoid eating or drinking, several hours before the test
  • The patient may be asked not to take any blood thinners, such as aspirin, NSAIDs, before the procedure
  • The physician may recommend blood tests before the procedure to check liver and kidney function

What is the Consent Process before the Procedure?

A physician will request your consent for Embolization of Arteriovenous Malformation and Fistula in Brain using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Embolization of Arteriovenous Malformation and Fistula in Brain procedure:

  • Embolization is a minimally-invasive procedure
  • The procedure requires less recovery time than an open surgery
  • There is no requirement for a large surgical incision; a small incision is sufficient enough to access the blood vessels, made either in the arm or leg
  • Embolization is very effective in prolonging life and relieving symptoms that results from an arteriovenous malformation

Following are the risks of the Embolization of Arteriovenous Malformation and Fistula in Brain procedure:

  • There is a slight chance of damaging blood vessels while using a catheter during the procedure
  • The skin is penetrated during the procedure and thus there is some risk of an infection
  • There is a chance of the embolic agent getting lodged in the wrong place and stopping oxygen supply to normal (healthy) tissues
  • There is a slight chance of illness or death, but very few cases require additional treatments or surgery

What are the Limitations of the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure?

Following are the limitations of the Embolization of Arteriovenous Malformation and Fistula in Brain procedure:

  • Recurrence of the condition after the procedure
  • Balloon stenting or microstenting may be used in the procedure to improve the success rate of the procedure
  • Follow-up checks are required to monitor the condition

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

  • What is the Embolization of Arteriovenous Malformation and Fistula in Brain procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
  • Is there any medication that needs to be taken for life after the procedure?
  • What are the costs involved?

During the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure:

What is to be expected during the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure?

The following may be expected during the Embolization of Arteriovenous Malformation and Fistula in Brain procedure:

  • The patient will feel a slight pinprick when the needle is inserted for the IV line
  • The patient will receive a general anesthetic and will be unconscious throughout the procedure
  • Sedatives may be used in the procedure to help the patient relax
  • The patient may feel slight pressure and a little discomfort when the catheter is inserted

What kind of Anesthesia is given, during the Procedure?

The patient is given a general anesthetic for the Embolization of Arteriovenous Malformation and Fistula procedure.

How much Blood will you lose, during the Procedure?

There is no significant blood loss involved during the embolization procedure.

What are the possible Risks and Complications during the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure?

The risks of the Embolization of Arteriovenous Malformation and Fistula procedure include:

  • There is a risk of infection as skin is penetrated for the IV line
  • In some cases, the procedure may cause pneumothorax, blood clots, or dislodging of the tube

What Post-Operative Care is needed at the Healthcare Facility after the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure?

There is no postoperative care necessary after an Embolization of Arteriovenous Malformation and Fistula procedure, at the healthcare facility.

After the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure:

What is to be expected after the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure?

  • In most cases, the patient may resume their daily activities after 24 hours
  • Headaches may result after the procedure that may last from 7 days to up to 6 months
  • Recovery after the procedure depends on the brain injury caused by bleeding from the leaking arteriovenous malformation
  • Many individuals return to their normal activities after 1 month and can begin to drive 3 months later

When do you need to call your Physician?

If there is a skin infection at the site of incision, or if the patient is feeling ill again, then he/she should notify the physician immediately. 

What Post-Operative Care is needed at Home after the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure?

The following post-operative care is necessary at home after the Embolization of Arteriovenous Malformation and Fistula in Brain procedure:

  • No heavy lifting or strenuous exercises is advised for the next 24 hours after the procedure
  • The patient is advised rest for a period of 24 hours
  • Prescription medications must be taken for their entire course 

How long does it normally take to fully recover, from the Procedure?

  • Generally, the patient may resume their daily activities after 24 hours
  • Headaches may result after the procedure that may last for up to 6 months
  • Many individuals are able to return to their normal activities after 1 month and begin driving 3 months later

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

There is no tissue extracted during the Embolization of Arteriovenous Malformation and Fistula in Brain procedure. 

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient. 

Who will you receive a Bill from, after the Embolization of Arteriovenous Malformation and Fistula in Brain radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the health care facility has with the physician and other health care providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • Radiologist or neurologist, performing the procedure
  • Healthcare providers, physicians, who is involved in the process

The patient is advised to inquire and confirm the type of billing, before the Embolization of Arteriovenous Malformation and Fistula in Brain procedure is performed.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: July 26, 2015
Last updated: Jan. 18, 2019