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Neurointerventional Surgery

Arteriovenous Fistula (AVF)

Procedures

What is an AVF?


An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein. An AVF can occur anywhere in the body, though they are most often found in the head, neck, spine, and liver. When there is a fistula in the brain, we call it an arteriovenous malformation (AVM). When a fistula occurs near the dura (the covering material of the brain), it is a dural arteriovenous fistula. Sometimes AVFs are present at birth (congenital) or develop after birth, and sometimes they are the result of an injury (acquired).

What are the symptoms of an AVF?


The connection between a high-pressure artery and a low-pressure vein can increase the blood flow in the area, and can expand both the artery and the vein. People with an AVF often experience swelling, pulsing, or vibration in the area of the AVF. When a doctor listens to the location with a stethoscope, there is often a or continuous murmur. Small arteriovenous fistulas often won't have any signs or symptoms and usually don't require treatment aside from monitoring by your doctor. Large arteriovenous fistulas may cause signs and symptoms, including bulging purple-colored veins similar to varicose veins; swelling in the arms or legs; decreased blood pressure; fatigue; and heart failure.

How is an AVF diagnosed?


Your doctor will listen to the blood flow in your body. Blood flowing through an arteriovenous fistula makes a sound similar to humming. If your doctor suspects a fistula, you'll have other tests to confirm your diagnosis. Tests to diagnose an arteriovenous fistula can include duplex ultrasound, in which sound waves are used to evaluate the speed of blood flow; CT angiogram, to see if blood flow is bypassing the capillaries; or magnetic resonance angiography (MRA), which can help locate arteriovenous fistula deep under your skin.

How is an AVF treated?


Treatment of AVF is complicated and generally requires a multidisciplinary team to evaluate and determine the best approach. This team consists of experts in many treatment approaches working together to prescribe the safest, most effective treatment plan for your arteriovenous fistula without bias towards one particular treatment.

Endovascular embolization is the most common form of treatment for an AVF. We perform this procedure by inserting a catheter into an artery (usually the femoral artery in the front of the hip). Then, guided by fluoroscopic or X-ray imaging, we move it to the location of the fistula. We inject contrast so that we can see the exact location of the AVF. Then we inject material into the exact location where the artery and the vein meet, to stop the blood flow. We use a variety of types of devices, including coils, detachable balloons, embolization glue, embolization particles, embolization material (called Onyx), and vascular plugs. Once we have closed the connection between the artery and the vein, the AVF is cured and usually does not reoccur.