Some individuals are born with defects in their blood vessels. Instead of capillaries, the tiny blood vessels that connect arteries to veins in an organ, they have a “short circuit” tangle of arteries and veins. This can interfere with normal blood circulation or result in bleeding, which can be catastrophic.
Arteriovenous malformations are uncommon but can be found in the brain and spinal cord. These weakened blood vessels run the risk of bursting and bleeding into the brain or spinal cord. It may take a combination of treatments to effectively treat arteriovenous malformations, including endovascular embolization, surgery and Gamma Knife (a type of advanced radiation treatment for tumors and other complex conditions in the brain).
What happens during endovascular embolization?
Before the procedure, you will have met with your neurointerventionalist in an office visit and discussed the procedure and its risks and benefits.
Prior to your procedure, we’ll take you to a preparation area where our nurses will start an IV in your arm and give you any medication that may be required prior to your procedure. We may give you medicines to protect your kidneys, antibiotics to help prevent infection, and anti-nausea medications. You may have a Foley catheter (tube) placed into your bladder.
We’ll take you to a special room similar to an operating room. This procedure is typically performed under general anesthesia. You will lie on your back on a table and we’ll clean the area where the catheter (a thin, hollow tube) will enter your body using a special solution to minimize infection. We’ll place sterile drapes over your body and apply a local anesthetic so you don’t feel any pain.
Your neurointerventionalist will make a small incision in your groin or upper thigh to insert the catheter and, using imaging techniques, will navigate the catheter to the blood vessels near the lesion. We will begin with an angiogram (blood vessel pictures) to map the blood vessels feeding the AVM. We’ll carefully advance a tiny microcatheter into the blood vessels feeding the arteriovenous malformation. Then, we’ll administer either tiny little particles specially designed to block the blood vessels, a special glue, or a substance called Onyx, into the malformation to stop the blood flow. After the procedure, we may take additional angiograms to be sure we treated the appropriate portion of the arteriovenous malformation.
At the end of the procedure, your neurointerventionalist will withdraw the catheter and usually place a special device in the blood vessel to stop the blood from leaking out. Finally, we’ll put a bandage over the incision.
After your procedure, your neurointerventionalist will review the results of your embolization with you and your physician or neurosurgeon so he or she can discuss the next steps with you. This may include surgery to remove the AVM.