Diagnosed 6 weeks ago with c3-t1 fistula. After my first visit with neurosurgeon today am going to be admitted to Nottingham hospital in a couple of days for another mri .. angiogram and then either Embolization or surgery. Extremely nervous as to what awaits. Is this normal procedure?
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Yes. I went to QMC as well.
The angiogram allows the consultant interventional radiologist to see the exact layout, size, etc of your arteries and any veins connected straight through. With an MRI you only get to look at a single slice at a time. Yes, you can animate the image by sliding up and down through the slices but it has to be a difficult way to see the layout of what is a 3D structure.
With the angiogram, they’ll do a local anesthetic and insert a very fine tube, a catheter, either at the top of your leg, into the femoral artery or at your wrist into the radial artery and then navigate it up to the area that they’re wanting to look at.
An iodinated contrast material is injected and it is visible on x-ray on a big TV screen above your head. The doc will inject it in a number of locations to see where the iodine flows to and effectively map out your AVM, compressing it into a flat image just of the illuminated blood vessels.
As the contrast is injected, it displaces the blood temporarily and the doc will tell you what to expect, “Hot flush” or “stars coming” or “You might feel a little nauseous” etc and sure enough, that’s what happens. Each flush lasts a few seconds but is enough for the doc to capture images that show the exact shape of the vessel that he or she is injecting into.
When you finish, the catheter is removed and the doc presses down hard on the wound to encourage it to seal. If I’m honest, this is uncomfortable. It’s like someone pressing hard on a bruise for a few minutes. And then it’s all done. If you’ve had an entry through your wrist, they’ll fit a compression band to keep the pressure on for a while. If they’ve gone in at your groin, you’ll be wheeled away to lie flat for a couple of hours while it heals enough to start moving around. You won’t be allowed to drive for 24 hours, I think.
There are risks associated with the procedure. The commonest perhaps is an intolerance of the iodinated contrast but they’ll sort you out if that’s the case. And there is a risk of having a stroke from the procedure. I’d say almost everyone here with a brain AVM has had an angiogram or three and I know of less than a handful who have had trouble with it.
The scans will allow them to then share that information in a Multidisciplinary Team Meeting (“MDT”) and agree between the diverse disciplines of neurosurgery which routes to recommend to you. I suspect it will also help them to categorise your risk and put you on the elective surgery schedule in the right place.
Hope that helps.
Richard
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Hello,
Embolization or major surgery depends on your surgeons assesment but also depends avm size and location. Hopefully All will go best And
Wish you early recovery to Normalization. Even if they go for surgery it ll be under GA so you ll not feel much. Do update us pls
Regards
Syed
That’s exactly how my procedure went - angiogram and mri and then embolization surgery a few days later for my spinal AVF. Took a while to get my feet under me again but now I’m much better off than I was prior to the surgery. Sending strength and prayers.
Yes. I had a heart cath where they then went into the AVM area to map it. Next procedure was an embolism with Onyx glue. Doing great 16 years later.
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Thank you for all the iinformation. I was admitted yesterday and being my first time in hospital is a lot to get your head round but trying to stay tough. Thankfully I can still walk but at a slower pace some weakness in arms and legs if trying to walk to quickly some back ache and some ache in back of neck with head pressure so I could be much worse on the bright side.
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It is.
So other than the angiogram, have they gone on to treat you, or are you waiting for next steps? My doc (Norman) at QMC did my angiogram and the embolization in one marathon sitting!
The angiogram is being done on Monday and depending on the outcome of that will then be having surgery. I’m not to sure how long they will wait to do surgery after the angiogram tho?
I’ve no idea. The spinal guys seem to get on with it pretty quickly. I waited 4-5 months between the QMC team calling me in to talk through my MRI and the operation. I had the angiogram at the same time as the embolization operation partly because the doc was comfortable with what he could see on MRI. He needed the angiogram to assess the operation but in terms of impact-assessing me, he was happy he could see enough on the MRI.
So I can’t give you any clues as to the plan for you, except that you’re already in hospital seems to me like they’re going to assess you, talk to you about it and then get on with it. It seems unusual to me to have an angiogram as an in-patient, so it seems likely you’ll be sorted next week.
Ask anything you like. We all understand the OMGness of going into hospital for this sort of thing. If we can offer anything from our own experience, we will. If you’d like a visitor, let me know privately. I’m driving from Carsington Water in the Peak District back to Leicester tomorrow, so could divert via QMC, but I am a brain DAVF patient, not a spinal patient: I can’t tell you so much that relates to your situation.
Best wishes,
Richard