AVM Embolisation

What is a Arterio-Venous Malformation (AVM)

An AVM is a tangled mass of malformed blood vessels in your head. These blood vessels are enlarged and therefore have a greater risk of bleeding.
 

An image showing an AVM — a small catheter is positioned in the cerebral vessels allowing both visualisation and treatment of the AVM

How can AVMs be treated?

There are three main ways of treating your AVM:

• Embolisation
• Stereotactic Radiosurgery
• Neurosurgery

Your consultant will discuss with you the most appropriate method(s) of treating your AVM.

What is an Embolisation?

An embolisation is a way of treating your AVM so that it is no longer at risk from bleeding.  AVM’s are treated using specially manufactured embolic materials, either particles, glue or coils, which are designed to reduce the flow through these enlarged blood vessels.

In most circumstances, embolisation is used to shrink an AVM so that it is suitable for Radiosurgery or Neurosurgery. Sometimes embolisation can treat your AVM completely.

This procedure will be carried out in several stages involving separate admissions to hospital over a number of months.

What is Stereotactic Radiosurgery?

A single treatment of high dose radiation directed specifically at the nidus centre) of the AVM.  This treatment is sometimes referred to as ‘gamma knife’ surgery. However, despite its’ name this procedure does not entail any surgical operation

What is Neurosurgery?

Neurosurgery is the longest established treatment option for AVM’s.  It involves creating an opening in the skull, called a craniotomy, allowing the neurosurgeon to surgically remove your AVM.

 

What happens before the embolisation?

You may already be in hospital, if you are not you will be sent a date to come in for the procedure.

If any of the following are applicable, please ring the  Neuroradiology Department as soon as possible on:

Telephone: (0191) 256 3347

• You take Warfarin (a blood thinning tablet).
• You are a diabetic and/or take Metformin.
• You think you may be allergic to x-ray dye.
• There is a possibility you may be pregnant.

You must not have anything to eat or drink from 3am on the day of your angiogram.

Please bring any medication/inhalers with you when you come into hospital.

Once you are in hospital, before your embolisation the doctor will come to explain the procedure to you and will ask  for your consent to carry it out.

What happens during your embolisation?

Your embolisation will take place in the angiogram room.

You will be asked to lie on the x-ray table. The anaesthetist will then give you a general anaesthetic, so that you will be fully asleep throughout your embolisation.  Once you are asleep the radiologist will begin the procedure by inserting a small tube into the blood vessel in your groin (this is called a sheath).  The whole of the embolisation will be carried out through this sheath.

A small catheter is placed through the sheath and up into the AVM.  The embolic material (particles, glue or coils) is then inserted via this catheter until the blood flow to your AVM is reduced. 

When this procedure is finished the anaesthetist will wake you up.

What happens after your embolisation?

When you are completely awake you will be transferred to the High Dependency Unit (HDU), a recovery ward, where you will stay overnight.

The nurses will take your blood pressure and pulse, and check your groin.

The following day you will be transferred to the ward.  You will be in hospital for a few days following your embolisation and then will be discharged home.

A minority of patients may experience localised scalp problems for some weeks or months following this procedure. This depends on how complex and lengthy the procedure turns out to be on the day, and cannot be predicted beforehand. You may well not experience any such problems; however if you do notice an area of skin irritation or hair loss, it is our experience that this is temporary. The irritation can be moisturised with aqueous cream and an area of hair loss will be more sensitive to strong sunlight until hair regrowth.

What happens after you leave hospital?

You will be sent an appointment to attend the Neurosciences Outpatient Department approximately three months after the procedure was carried out.  A check angiogram will be performed about six months after the procedure.

If you have any questions concerning this test please ring the Neuroradiology Department on:

Monday to Friday 8:30am to 5:00pm

Telephone (0191) 282 5413

If you have any problems after your angiogram, outside of normal working hours, please contact your GP, or your local Accident & Emergency Department. 

In an emergency you can contact the Senior Nurse in Charge for Neurosciences at the Newcastle Royal Victoria Infirmary via the switchboard on:

Telephone: (0191) 233 6161