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Arteriovenous Malformations (AVMs) & Arteriovenous Fistulas (AVFs)

Endovascular embolisation and sclerotherapy for peripheral arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) performed by Dr. Gurucharan S Shetty at Sparsh Hospitals Bangalore. Minimally invasive treatment for complex vascular lesions.

Vascular Interventional Radiology

What is Arteriovenous Malformations (AVMs) & AVFs?

Arteriovenous Malformations (AVMs) are congenital vascular lesions consisting of a nidus of abnormal vessels directly connecting arterial feeders to venous drainage bypassing the normal capillary bed. Arteriovenous Fistulas (AVFs) are abnormal direct arteriovenous connections, often acquired after trauma, surgery, or interventional procedures. Both conditions can cause bleeding, tissue damage, cosmetic deformity, pain, and in large lesions, high-output cardiac failure. Endovascular embolisation and percutaneous sclerotherapy are the cornerstone of modern AVM and AVF treatment minimising surgical risk and providing targeted, effective treatment.

Who is This Procedure For?

Arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) require treatment when they produce symptoms or carry a significant risk of haemorrhage. Indications include symptomatic AVMs presenting with pain, swelling, a pulsatile mass, bruit, progressive skin changes, ulceration, or tissue necrosis (Schobinger Stage II–IV). Treatment is also warranted in lesions with a high risk of bleeding, such as those with prior haemorrhage, rapid growth, or high-risk angiographic features. Cosmetically significant lesions that lead to psychological distress, disfigurement, or noticeable skin discolouration are another important indication. Acquired AVFs, whether post-traumatic, iatrogenic (such as after biopsy or catheter procedures), or post-surgical, may require intervention when they result in haemorrhage, venous hypertension, or ischaemia. Additionally, pre-operative embolisation is often performed to devascularise AVMs before surgical resection, reducing intraoperative blood loss. Treatment is also considered for venous malformations, which are low-flow vascular anomalies that can cause pain, swelling, and functional limitation.

How Are AVMs Treated Endovascularly?

  • Diagnostic Angiography & Mapping

    Comprehensive angiography characterises the AVM nidus, arterial feeders, venous drainage pattern, and any associated aneurysms essential for treatment planning.

  • Multi-disciplinary Planning

    Discussion with vascular surgery, plastic surgery, and radiosurgery teams to determine the optimal combination of endovascular, surgical, and/or radiosurgical treatment.

  • Superselective Catheterisation

    Microcatheter is advanced into individual AVM feeding arteries as close to the nidus as possible minimising off-target embolisation of normal tissue.

  • Embolisation / Sclerotherapy

    Liquid embolic agents (Onyx, NBCA glue) are injected for arterial components. Direct puncture sclerotherapy (ethanol, bleomycin, STS foam) treats venous components.

  • Post-treatment Assessment

    Angiography confirms extent of occlusion. Repeat sessions planned at 6–8 week intervals for larger or complex lesions.

Benefits of This Procedure

Avoids Open Surgery

Endovascular treatment dramatically reduces the need for complex, high-risk surgical resection in many AVM cases.

Reduces Haemorrhage Risk

Embolisation eliminates high-flow feeding vessels and reduces the risk of spontaneous or traumatic haemorrhage from the AVM.

Enables Safer Surgery

Pre-operative embolisation reduces tumour vascularity making subsequent surgical resection safer and more complete.

Personalised Treatment

Each AVM is unique Dr. Shetty creates an individualised multi-stage treatment plan tailored to the lesion's anatomy, symptoms, and risk profile.

Frequently Asked Questions

Complete cure by embolisation alone is possible for small, simple AVMs but is less common for large or complex lesions. For most significant AVMs, the goal of endovascular treatment is symptom control, haemorrhage prevention, and size reduction often as part of a combined approach with surgery or radiosurgery. Dr. Shetty sets realistic expectations during consultation, emphasising that AVM management is often a long-term process.
AVMs can remain stable for years but may enlarge particularly following trauma, surgery, inadequate treatment (proximal ligation), hormonal changes (puberty, pregnancy), and infection. Partial treatment that only eliminates some feeding vessels without treating the nidus can paradoxically stimulate AVM growth through recruitment of new feeding vessels. This is why complete nidus treatment is the goal in every case.
Venous malformations (VMs) are low-flow vascular anomalies of venous channels that are distinct from AVMs they have no high-flow arterial component. They present as soft, compressible masses that swell with dependency and the Valsalva manoeuvre. VMs are treated primarily with percutaneous sclerotherapy using sodium tetradecyl sulphate or bleomycin injected under ultrasound or fluoroscopic guidance. Multiple sessions are often required. Sclerotherapy is highly effective for macrocystic VMs and gives excellent long-term results.
Liquid embolic agents (Onyx, NBCA) can occasionally migrate beyond the target AVM potentially causing embolisation of normal tissue. This risk is minimised by superselective catheterisation (advancing the microcatheter as close to the nidus as possible) and careful, slow injection technique under live fluoroscopic monitoring. In skilled hands, serious non-target embolisation is rare (<2% of cases).
Recovery depends on the location and complexity of the AVM and the treatment approach. Most patients are observed for 1–2 days after each embolisation session. Swelling, bruising, and pain at the treated site typically resolve over 1–4 weeks. Activities are gradually resumed based on healing progress and the location of treatment.
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Diagnosed with an Arteriovenous Malformation or Fistula?

Consult Dr. Gurucharan S Shetty at Sparsh Hospitals, Bengaluru for specialist evaluation and a personalised, minimally invasive treatment plan.

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