Meet Dr. Gyorke, Tucson physician
Arteriovenous malformation (AVM) is an abnormal connection between arteries and veins that bypasses the capillary system. Although many AVM’s are asymptomatic, they can cause bleeding or lead to other serious medical problems. An embolization is a specialized, controlled blocking of the blood supply to the AVM with coils, particles, or glue. Dr. Ashdown, Dr. Gyorke, Dr. Jeck and Dr. Rucker, are trained in all aspects of neuroembolizations, and perform these procedures for Radiology Ltd. in Tucson.
An Arteriovenous Malformation, commonly called an “AVM”, is an abnormal connection between an artery and a vein. There are two main types: Brain AVM and Dural AVM. Brain AVM involves the blood vessels inside the brain, while Dural AVM involves the blood vessels lining the brain.
Brain AVM may cause seizures or severe headaches, in which case it is usually detected on a CT or MRI scan. Brain AVM may also rupture and cause bleeding in your brain, which is a serious emergency. Dural AVM usually presents with characteristic symptoms such as a swollen red eye or a whooshing sound that matches your heartbeat (tinnitus). Dural AVM is often detected on MRI, though a cerebral angiogram may be necessary to detect small lesions.
First a cerebral angiogram is performed, in which a small tube (catheter) is inserted into a blood vessel in your groin and advanced into the blood vessels that go to your brain. An iodine-based contrast material is injected to see the blood vessels and demonstrate the abnormal connection between the artery and the vein. After the abnormal connection is found, an embolization procedure is performed.
An embolization is a specialized, controlled blocking of an abnormal blood vessel, either an artery or vein, depending on the type of AVM. A very tiny tube (microcatheter) is carefully placed in order to perform the blockage. A variety of blocking agents can be utilized, including coils, particles (tiny shavings of a plastic type material), or “superglue”. The type of embolization and blocking agent depends on the individual AVM and is tailored to your specific case.
Treatment of a Brain AVM will usually involve combined treatments with a Neurosurgeon and an Interventional Neuroradiologist, depending on its size and location. The Interventional Neuroradiologist usually performs an embolization prior to the surgery.
Treatment of a Dural AVM does not usually involve an additional surgical procedure. The Interventional Neuroradiologist can usually block the involved blood vessel, either the artery or the vein, to cure the problem.
Prior to your procedure, you will have a thorough consultation with our Neuroradiology Nurse Case Manager and one of our Interventional Neuroradiologists. All possible treatment options will be reviewed and discussed with you in detail, and all of your questions will be answered. If embolization of your AVM is the treatment of choice for you, Radiology Ltd. will make the necessary arrangements for you.
After registering at the hospital, you will be sent to the Special Procedures Area, where you will have an intravenous (IV) line placed in your arm and a tube (Foley catheter) placed into your bladder. Fluids and pain medication will be given prior to your procedure. You will then be sent to the Interventional Suite in the Department of Radiology, where you will meet with your doctor (Interventional Neuroradiologist) and the nurses and technologists trained in this procedure. For treatment of a Dural AVM, you will be given sedation for relaxation and discomfort but will be conscious during the procedure. For treatment of a Brain AVM, you will undergo general anesthesia and will be asleep throughout the procedure.
A catheter (or plastic tube) will be advanced into the femoral artery located in your groin region and then advanced into the arteries leading to your brain. An angiogram will then be performed, in which images of the blood vessels are obtained during an injection of iodine-based contrast material. Once the abnormal connection between the artery and vein is well visualized, the embolization will be performed. At the end of the procedure, the catheter will be removed. You will usually be observed in the hospital overnight. Most patients go home the next day and can return to normal activity within a couple of days.
Significant complications related to AVM embolization are uncommon. The primary risks associated with this procedure include:
- Groin hematoma or bruising
- Allergic reaction to the contrast material
For your safety and the protection of others, we do not allow anybody except patients in our exam rooms.
Your procedure will be performed by Dr. Ashdown, Dr. Gyorke, Dr. Jeck, or Dr. Rucker, all of whom are Senior Members of the American Society of Interventional and Therapeutic Neuroradiology (ASITN). They are trained in all aspects of neuroembolizations and are very experienced, with one of the most successful Interventional Neuroradiology practices in the country. For more information or clinical questions, please call Faith Johnston at (520) 901-6616. To schedule a consultation, please call Tracey Bassett at (520) 873-3724.