I’m looking for some perspective on this, because I’m pretty upset. I posted a few months ago about my dillema over whether or not to go ahead with treatment again. Well, I decided to do so. I was supposed to have my embolization today. They put me under, I believe used ultrasound, and put about 40 needle points in my foot trying to get to the AVM/VMs but apparently were unable to. They didn’t treat at all. After the surgery, the IR said he wanted to try again with an arteriogram next time. I was still coming out of anesthesia and didnt have all my wits about me, but now I’m realizing - I’ve had 2 embolizations before, both times an angiogram was used by default. Isn’t that common practice? Have you ever had embolization WITHOUT an angiogram/arteriogram?
I will acknowledge I’m also sour about the treatment in other aspects - so I want to be sure thats not coloring my take on this angiogram thing. Thanks for sharing your experience.
So, I’m guessing it depends on the approach route.
It sounds like they tried to approach your AVM/VM percutaneously – i.e. directly through the skin – and so ultrasound as the viewing medium makes some sense.
However, if the approach for embolization is transarterial or transvenous– i.e. by threading a catheter through your arteries or veins to get there – then you’ve already got a catheter in place to visualise the vessels. The most effective method is going to be to inject some contrast material through the catheter and see what is where on an X ray. Then, do the embolization using the same catheter.
There are risks associated with catheter embolization, so going percutaneously might have been an option for you to avoid those risks but if that hasn’t been successful, it does seem much more common to go in via the femoral artery.
I’m a brain AVM person, so it is almost always transarterial (because the skull otherwise gets in the way) though I did read a brain AVMer being offered a percutaneous approach through one of the cranial foramens (a small natural hole in the skull) the other week! So it does sound to me like they tried a normal, lower risk approach with you but without success.
I’d expect that passing a catheter transvenously is higher risk than transarterially because the walls of the veins are less strong. To attack a VM, that may be the only other route, so it makes sense to try the percutaneous route first if the focus is your VM rather than AVM.
I think your difference from many is going to be your VM. I’m not a doctor, so I don’t know how these things are done but just working it through logically like I did above, most people here have an AVM and that means there is an arterial side to the lesion. With a VM, I’m guessing there may well not be an arterial access to it, so directly from the outside (percutaneously) is one available access, and via the veins (transvenous) is the other access. It only occurred to me when writing to you today that a transvenous approach may well be more risky, hence trying out the percutaneous route first. The whole risk with an AVM is that veins are not as strong as arteries, so a transvenous catheter embolisation sounds to me like it would have more risk associated with it than transarterially.
The other thing that happens with embolisations is that sometimes you close off your access route even if you don’t fill the whole AVM first time, so a different route has to be followed subsequently. If you have an AVM with a VM associated, it could be that the embolisations done previously have closed off access to the VM even if not everything was glued up wholly first (or second) time.
Always ask the doctors about how they are treating you (and why) but I think these could be good reasons why you’re getting a different treatment plan than before. It’s very disturbing to have a treatment and it get abandoned but I’m not sure it indicates anything other than that they are looking after you as well as possible.
I’m glad that my logical thinking through might help! If there’s anything else that would help to explain further based on stuff I’ve experienced, read about or just thinking logically, let me know.
I am so amazed they had you making decisions when you were not totally aware of everything. I hope everything turns out well for you. Keeping you in my thoughts and prayers.