Endovascular Management of Dural Arteriovenous Fistula

What conditions does this treatment treat?

A dural arteriovenous fistula (dAVF) refers to an abnormal connection between an artery and a vein, within the dura mater of the brain. The dura mater is a tough outer covering in the brain. When a dAVF forms, blood from the artery which is usually high in pressure flows into the vein, which normally carries blood that is lower in pressure.

This interferes with the normal circulation of blood in the brain, and eventually could lead to brain dysfunction and hemorrhage in your brain if there is rupturing. This could also lead to an increase in pressure around the spinal cord.

Dural AVFs mainly affect people later on in life (50 years old and older) and do not have a link to genetics, and in most cases, they are idiopathic, meaning that doctors cannot directly pinpoint a clear cause for why you have developed a dAVF. 

What is this treatment? What is expected during this treatment?

Minimally invasive endovascular embolisation can be done to cure the majority of dAVFs. 

You will be put under general anaesthesia by an anaesthesiologist. A small incision is made in one or both legs, or the groin, in order to insert the stent into your artery where the dAVF is. This means there will be no obvious surgical scar. 

During the surgery, X-ray fluoroscopy will be used to guide the catheter towards the fistula. The interventional neurologist will position the catheter and different agents like metal coils, embolizing agents (small plastic particles) and glue-like substances are delivered through the catheter in order to help the dAVF to close up, through shutting off the artery and reducing blood flow through the dAVF.

There is a shorter recovery time for endovascular embolisation as compared to other surgery options like surgical resection. After the surgery, you will be expected to lie in bed for the next 6-8 hours. This procedure would normally require 2-3 days of hospital stay, but you will typically be able to return to daily activities within a couple of weeks.

How will it improve your condition and affect your life? (e.g. change in QOL, change daily tasks, etc.)

Post-surgery, you will find that your symptoms of the dAVF (neck pain, whooshing noises in your ears, headaches etc) improve in 1-2 weeks. You will be asked not to engage in any strenuous activity for the first week or so whilst you recover, but everything should return to normal after that.

What are some possible side effects or risks?

In general, this procedure is a very safe one, although complications and side-effects are always a possibility. Some possible surgical risks include allergic reactions to the injected material, as well as damage to the blood vessel and minor bruising or heavy bleeding at the site of the catheter insertion. With every endovascular embolisation, there is also a small risk of surgical infection, seizures and hemorrhage leading to stroke during the procedure.

What do I do after I get this treatment?

After the endovascular embolisation procedure has been completed, you will probably need to return for a few check-ups, but minimal follow-up medication will be required and you can more or less resume your daily activities. 

If you have any questions about this procedure, do seek clarification with your doctor and find out whether this treatment is suitable for you.