Embolization – Dural Arteriovenous Fistula

Embolization is a general term for closing off or occluding a vessel. A dural arteriovenous fistula (dAVF) is an abnormal connection, or short circuit, in the covering of the brain or spinal cord. The reason these cause problems is that the blood drainage of the brain and spinal cord connects to the veins of the dura. The dAVF or short circuit results in too much pressure in the veins of the brain and can result in bleeding in the brain or in the fluid around the brain—a condition which can result in stroke and death. This procedure is performed to plug the abnormal connection, restoring normal circulating and receiving the dangerous increased pressure in the veins or the brain or spinal cord.

Endovascular embolization is a treatment where a catheter is placed into an artery in your groin or wrist and directed under an x-ray camera to the vessels that need to be closed. Typically, a smaller catheter is positioned into the vessel as close to the site of occlusion (closure) as possible. Material is then injected or advanced through the smaller catheter to achieve vessel closure. The material may be small coils, small particles or a liquid material that hardens in the vessel. This is generally done using anesthesia.

All medical procedures have risks. The risks of embolization can include bleeding of the vessel in the groin area or wrist. Less common is closing off a vessel that goes to a structure or organ that is vital to function, causing symptoms. In the head and neck area. Stroke is the most concerning risk, as the vessels are all connected to branches that go to the brain. Nerves that come out at the base of the skull or spine could also become injured by loss of blood supply. These nerves control motor and sensory function to the face and eye, as well as vision. In some cases, a very long procedure could also lead to radiation injury, leading to loss of hair or skin burns.  

As with any medical procedure, you should talk to your doctor about the risks versus the benefits of the procedure.

If anesthesia or sedation is planned, you may not eat or drink for at least six hours prior to the beginning of the procedure. X-ray dye is used to map the blood vessels, so if you have a history of allergy to x-ray dye, you will need to start pretreatment medications the day before your procedure. Most embolizations can be done with a short hospital stay.

Some pain at the site of puncture is common; this usually eases after 2 – 3 days, but may persist for up to a month. Some patients will have some soreness at the site of embolization for a few days. This is normal and typically responds to over-the-counter pain medications. Some patients report feeling a little more tired than usual for the first few weeks after the procedure. This is normal and tends to wax and wane, but overall gets better over the course of a few weeks.