Mayo Clinic Study Finds that Surgical Treatment of Arteriovenous Fistulas Is Safe and Effective

Monday, May 04, 2009

ROCHESTER, Minn. — A new Mayo Clinic study found that surgical treatment of spinal arteriovenous fistulas is safe and effective. Newer techniques like endovascular embolization have not yet been demonstrated to be as effective, and therefore must be studied further in order to be recommended over traditional surgery. This study will be presented at the American Association of Neurological Surgeons Annual Meeting in San Diego on May 5.

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A spinal arteriovenous fistula is an abnormal tangle of blood vessels that develops near the base of a spinal nerve. These fistulas cause spinal tissue to be starved of normal amounts of oxygen, and therefore, cells begin to die. The fistula may rupture and cause a spinal hemorrhage. Symptoms vary greatly, but may include tingling, numbness or progressive weakness in lower extremities, burning pain and bladder problems. Spinal arteriovenous fistulas occur most often in men older than 40.

"The preferred treatment for spinal arteriovenous fistulas is surgery to remove the fistula and correct communication between the artery and the vein in order to improve or stabilize symptoms," says Giuseppe Lanzino, M.D., a neurosurgeon at Mayo Clinic and the lead author of this study. "As endovascular treatments advance, embolization is more frequently being considered for patients with spinal arteriovenous fistulas. This procedure is similar to an angiogram, where a catheter is inserted into a leg artery and threaded through the body to the spinal arteries. The catheter is positioned in an artery that feeds the fistula and small particles or a glue like substance are injected to block the vessel and reduce or eliminate blood flow into the fistula."

Dr. Lanzino and his team reviewed the records of more than 150 patients with spinal arteriovenous fistulas who underwent surgery between June 1985 and March 2008. In 95 percent of the patients, the surgery resulted in complete removal of the fistula at first attempt and surgical complications were rare. After surgery, 96 percent of patients experienced improvement or stability of their motor function.

"This study shows that surgery is a safe and effective treatment for patients with arteriovenous fistulas. Newer endovascular embolization methods must be demonstrated to be as effective and safe before it is appropriate to recommend that treatment to the majority of patients with this condition," says Dr. Lanzino.

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