What is an arteriovenous malformation repair?

An arteriovenous malformation repair is a type of surgery. It removes a group of tangled blood vessels. This is called an arteriovenous malformation or AVM. The blood vessels in an AVM may get weak and leak or burst. This can make the tissue near it bleed.

An AVM can happen in many areas of the body. But it is often found in the brain. An AVM in the brain may cause seizures.

Before the surgery, you will go to the hospital to have an angiogram of your head. This is a type of X-ray test. It uses a special dye and camera to take pictures of blood flow in the blood vessels of your head. At this time, you may also have a procedure called AVM embolization. It sends tiny particles or a glue-like liquid into the AVM to block blood flow to it. This can make it easier for the doctor to remove the AVM during your surgery.

To do the surgery, the doctor will make a cut in your scalp. This cut is called an incision. Then the doctor takes out a part of your skull bone so he or she can reach your brain. Next, the doctor removes the AVM in one of two ways. It may be cut out or the doctor may use a laser to remove it.

After the AVM is removed, the doctor uses small metal plates and clamps to put back the piece of your skull. Then the doctor closes the incision with stitches or staples.

You will probably spend about 5 days in the hospital.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

What happens before surgery?

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctors ALL the medicines and natural health products you take. Some of these can increase the risk of bleeding or interact with anesthesia.
• If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.
• Your doctor will tell you which medicines to take or stop before your surgery. You may need to stop taking certain medicines a week or more before surgery. So talk to your doctor as soon as you can.
• If you have an advance care plan, let your doctor know. Bring a copy to the hospital. If you don't have one, you may want to prepare one. It lets your doctor and loved ones know your health care wishes. Doctors advise that everyone prepare these papers before any type of surgery or procedure.

What happens on the day of surgery?

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be cancelled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewellery and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery centre

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• When you are asleep, a doctor or nurse will shave part of your scalp. This is where the incision will be made.
• The surgery usually takes 1 to 4 hours. But in some cases it could take up to 12 hours.
• You may need to have another angiogram of your head. This is to see if the AVM was completely removed.

Going home

• Be sure you have someone to drive you home. Anesthesia and pain medicine make it unsafe for you to drive.
• You will be given more specific instructions about recovering from your surgery. They will cover things like diet, wound care, follow-up care, driving, and getting back to your normal routine.

When should you call your doctor?

• You have questions or concerns.
• You don't understand how to prepare for your surgery.
• You become ill before the surgery (such as fever, flu, or a cold).
• You need to reschedule or have changed your mind about having the surgery.