Dural Arteriovenous Fistulas (dAVFs) are abnormal connections between arteries and veins in the dura mater, the thick membrane surrounding the brain and spinal cord. Instead of blood flowing from arteries to capillaries to veins, dAVFs create direct high-pressure arterial flow into veins, causing venous hypertension, brain swelling, seizures, hemorrhage, and neurological symptoms.
Dural AVF Embolization is a catheter-based, minimally invasive treatment that blocks these abnormal connections and restores normal blood circulation in the brain. This treatment is often curative, especially when performed early.
At CARE CHL Hospital, Indore, Dr. Alok K. Udiya, a leading Interventional Neuroradiologist, performs this advanced procedure using cutting-edge embolic materials and high-resolution biplane DSA systems, achieving excellent results even in complex cases.
Key Benefits of the Treatment
Dural AVF Embolization is a game-changing treatment that provides:
- Curative Outcome: One-time embolization can completely eliminate the fistula.
- Prevention of Brain Hemorrhage: Stops venous congestion that can lead to life-threatening bleeding.
- Minimally Invasive: Avoids the need for open brain surgery.
- Rapid Symptom Relief: Many patients experience instant improvement in headaches, vision issues, or seizures.
- Short Hospital Stay: Most patients are discharged in 24–48 hours.
- Low Recurrence Rate: With complete embolization, recurrence is extremely rare.
- Suitable for All Ages: Effectively treats dural AVFs in both young and elderly patients.
How This Treatment Works
Dural AVFs are treated using a combination of angiographic imaging, microcatheters, and precision embolization agents to seal off abnormal arterial-venous connections.
1. Diagnosis and Grading
Common symptoms of dAVF include:
- Pulsatile tinnitus (hearing sound in the ear)
- Severe headaches
- Seizures
- Eye bulging or redness (in cavernous sinus dAVFs)
- Stroke or bleeding in severe cases
Diagnostic tools:
- MRI/MRA: Detects brain swelling or venous congestion.
- Digital Subtraction Angiography (DSA): Gold standard to identify feeding arteries, fistula point, and drainage pattern.
Dural AVFs are classified using:
- Cognard Classification
- Borden Classification
These help determine the risk of hemorrhage and the need for urgent intervention.
2. Pre-Procedural Preparation
- Routine blood tests, renal profile, and allergy history are reviewed.
- Dual antiplatelet therapy may be started based on the approach.
- Fasting for 6–8 hours is usually recommended.
- General or local anesthesia is chosen based on the AVF location and complexity.
3. The Embolization Procedure
- A catheter is inserted into the femoral or radial artery and advanced to the arterial feeders of the dAVF.
- A microcatheter is precisely guided to the fistula site.
- Liquid embolic agents like Onyx, NBCA glue, or coils are injected to seal the abnormal communication.
- In some cases, a transvenous route is used to access and block the draining vein.
- Procedure time ranges from 1–2.5 hours, depending on complexity.
4. Post-Procedure Recovery
- Patients are monitored in the ICU for 24 hours.
- Neurological assessments are performed regularly.
- Most patients are discharged within 1–2 days.
- Follow-up imaging (DSA or MRI) is done after 3 months to confirm cure.
Why Choose Dr. Alok K. Udiya at CARE CHL Hospital?
Dural AVF embolization demands a deep understanding of brain vascular anatomy and mastery over complex microcatheter techniques. Dr. Alok K. Udiya brings both:
- Hundreds of successful embolizations, including high-grade and ruptured dAVFs.
- Expertise in transarterial and transvenous techniques.
- Access to high-end biplane neuro DSA for accurate visualization.
- Skilled in using all major embolic agents (Onyx, NBCA, coils).
- Works in coordination with neurologists, neurosurgeons, and stroke teams.
- Proven track record of low complication and high cure rates.
FAQs – Dural AVF Embolization
Q1. What causes dural AVFs?
They may be congenital, develop after head trauma, surgery, or occur spontaneously due to venous thrombosis or infection.
Q2. Are dAVFs dangerous?
Yes. High-grade dural AVFs can cause brain hemorrhage, seizures, stroke, or death if left untreated.
Q3. What is the difference between a dural AVF and brain AVM?
AVMs are congenital tangles of arteries and veins, whereas dural AVFs are acquired connections between dural arteries and dural veins or sinuses.
Q4. How successful is embolization for dAVFs?
Success rates exceed 90–95%, especially for low- and intermediate-grade dAVFs.
Q5. Will I need surgery after embolization?
In most cases, no surgery is needed. Embolization alone is curative. Rarely, surgery or radiosurgery may be considered if the embolization is partial.
Q6. Is the procedure painful?
No. It is performed under sedation or general anesthesia. Discomfort post-procedure is minimal.
Q7. Are there any risks?
Minor risks include:
- Catheter-related complications
- Non-target embolization
- Transient cranial nerve weakness (especially in cavernous sinus dAVFs)
Q8. Will symptoms go away immediately?
Yes, in many cases. For example, tinnitus or eye symptoms may resolve immediately after embolization.
Q9. Can dAVFs come back?
Recurrence is rare after a complete embolization. Follow-up imaging helps ensure long-term success.
Q10. Is this covered under insurance?
Yes, most insurance plans and health schemes cover dural AVF embolization under neurovascular interventions.