Dural Arteriovenous Fistulas

Overview

Arteriovenous fistulas (abnormal passageways between arteries and veins) may occur anywhere in the body. Dural arteriovenous fistulas occur in the dura mater, the tough fibrous membrane that envelops the brain and spinal cord outside the arachnoid and the pia mater (the other layers of membrane that protect the brain and spine.)

Mayo Clinic is a world leader in the diagnosis and treatment of dural arteriovenous fistulas. In Mayo's efficient system, experienced and highly trained specialists from Neurology, Ophthalmology, Neuroradiology and Neurosurgery work together to determine the most appropriate treatment for patients with dural arteriovenous fistulas.

Dural arteriovenous fistulas are uncommon, and treatment may be complicated. But outcomes that may take weeks to accomplish in other settings can be achieved in days in Mayo's efficient system.

Mayo Clinic in Rochester, Minnesota, is ranked among the Best Hospitals for Neurology, Neurosurgery and Ophthalmology care by U.S. News & World Report.

Diagnosis

Some patients with dural arteriovenous fistulas hear noises that have no origin, their ears ring, or they have headaches or strokelike symptoms or seizures. Others have no symptoms.

Mayo Clinic specialists often suspect a dural arteriovenous fistula because of a bruit (a harsh and abnormal sound) heard with a stethoscope held over an artery. The bruit indicates excessive blood flow between the artery and a vein. To check further, Mayo's specialists may request magnetic resonance imaging (MRI) or 3-D rotational angiography to confirm the diagnosis.

In Mayo's unique system, radiologists, neurosurgeons and interventional neuroradiologists with recognized expertise in treatment of dural arteriovenous fistulas consult to confirm the diagnosis and determine the most effective care for each patient.

Learn more about diagnosis of dural arteriovenous fistulas.

Treatment

Large dural arteriovenous fistulas usually require treatment, which may include endovascular embolization (closure of the fistula from inside the blood vessel) or surgery to block the abnormal channel. Smaller fistulas sometimes close without treatment.

Mayo Clinic specialists incorporate the latest technological advances, including endovascular therapy, microsurgery and stereotactic radiosurgery using Gamma Knife™, to treat dural arteriovenous fistulas. At Mayo, teams of specialists evaluate different techniques or combinations of available alternatives to determine the most appropriate treatment for each individual.

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About Dural Arteriovenous Fistulas

Dural arteriovenous fistulas are abnormal passageways between an artery and a vein that occur in the outer of three membranes that enclose and protect the brain and spinal cord.

Normally, blood flows from the arteries through capillaries and returns to the heart through veins. When a dural arteriovenous fistula is present, blood flows directly from an artery into a vein, bypassing capillaries. If the volume of diverted blood flow is large enough, tissues downstream receive less blood supply. Heart failure may also occur due to the increased volume of blood returned to the heart.

Dural arteriovenous fistulas can occur at any age or may be congenital (present at birth). Some fistulas are life-threatening, some cause discomfort, and others are benign and go undetected.

Those who have diabetes, individuals with compromised immune systems (for example, AIDS or cancer), and individuals with certain gastrointestinal diseases (Crohn's disease, inflammatory bowel disease) are at increased risk of developing fistulas.

Read more about arteriovenous fistulas at www.MayoClinic.com.