A spinal dural arteriovenous fistula (SDAVF) is an abnormal connection between arteries and veins in the dura, the outer lining of the spinal cord.
Normally, arteries and veins are connected by tiny vessels called capillaries. Capillaries handle the transition from higher to lower pressure, help supply nutrients from the blood to surrounding tissues, and help move waste products from the tissues to the blood. In an SDAVF, the capillaries are missing and arteries and veins are directly connected to each other.
The abnormal connection can lead to a number of problems. For example, without capillaries, high-pressure arterial blood rushes directly into veins. Veins are not equipped to handle this influx. They can swell, and blood flow through them can become congested. Ultimately, this leads to swelling, which places harmful pressure on the spinal cord. Additionally, without capillaries to handle nutrient exchange, the tissue around the SDAVF can have difficulty receiving nutrients like oxygen and glucose.
Any issues with blood flow, pressure, and nutrient delivery can cause injury to the tissues around the SDAVF, which can result in neurological dysfunction over time.
A fistula is commonly discovered by MRI. An MRI of a patient with a dural fistula shows large veins surrounding the spinal cord. The cord may show evidence of swelling (edema) and enhancement if MRI contrast is given.
Once the diagnosis of a fistula is made, the next step is evaluation of the fistula using a spinal angiogram. In order to confirm the location of the fistula, a minimally invasive procedure called a spinal angiogram is necessary. Using image guidance a catheter is navigated into the aorta and other vessels which can give rise the fistula. Once the location is identified, the anatomy of the fistula is evaluated to see if it can be treated.
The vast majority of fistulas can be treated through catheter embolization, sometimes at the same time as the spinal angiogram. This allows for both the diagnosis and treatment to be completed during the same procedure.
During an endovascular embolization, your neuro interventionalist will insert a tiny catheter (flexible tube) into an artery in your groin and guide it up to the fistula to block the blood flow between the artery and the vein. Platinum coils or other materials, such as surgical glue, may be used to block the blood flow.
If embolization treatment is not possible, the fistula can be closed surgically.
Once the fistula is closed, spinal cord blood circulation improves, but usually does not go back to normal because a number of veins draining the spinal cord have already been damaged. Symptoms may go away completely, partially, or not at all. The extent of eventual improvement depends on duration and severity of pre-treatment symptoms, individual anatomy, and other considerations. The goal of treatment is to prevent further neurologic dysfunction and possibly improve some of the resulting neurologic deficits.
If you have been diagnosed with a spinal dural fistula and are exploring your options for treatment, call IVC today at 503-612-0498 to schedule an appointment for consultation.
* This information about Spinal Angiography and Spinal Dural Fistula Embolization was reviewed by Dr. Jason R. Bauer. If you have any questions, please don’t hesitate to contact us using the form below.
Dr Jason Bauer performed our 20 year old son’s kidney biopsy last week. I have had a lot of experience with medical care. Dr Bauer has moved to the top five of all doctors we have encountered. He has taught us more about our son’s medical condition than any other doctor has since March 2019! I just kept wanting to ask him more questions 😄. I felt super confident that our son was getting the best care he could when I let him go into the procedure. Dr Bauer’s skill, knowledge and ability to translate it into lay peoples terms far exceeded FIVE STARS and our expectations. He also related to our young adult son well which put him at ease.
A.R.Wonderful nurse, did a good job. I am thrilled and excited. (EVLT Patient)
C.W.If I have to have another drain ever I will come to IVC. Everyone is so great there.
P.P.Your office has done a great job at follow up.
E.M.You all are so nice. Thank you for being there. Your facility is so great. So happy not to have to go to the hospital for this.
P.A.You all were wonderful. My experience started with the pre-procedure call – where comfort, trust and confidence was gained. Mary Anne is an asset. Thanks to Vicky, Paul and Dr. Pfister for their true care & concern.
M.I.Thank you all, the team was great to work with. I appreciate your care.
C.D.Your team is exemplary. This leads to outstanding results. Thank you for being great!
I.S.Everyone at the oncology clinic said how great the port looked today!
S.V.M.Thank you for the time you spent with me today on the phone. You made a big difference. More than I can express. You have given me hope, calmed my anxiety and informed me. I was getting confused by all of the different instructions and restrictions by others.
R.M.You made this painless. Your team works together well. Thank you. I feel better already!
M.R.Best doctors in town! Dr. Zhang speaks fluent Mandarin which was very helpful to my uncle!
A.C.You guys were so AWESOME! Thank you for making this scary procedure go smooth and making me comfortable. You all are great.
C.P.I am a medical oncologist who has been referring my patients to the physicians at IVC for 8 years now. In my career, I have never worked with a more dedicated, thorough, humane, and technically superb group of physicians. I have received countless words of positive feedback from my patients echoing the above sentiments.
More recently, I have been a patient with Dr. Michael Pfister. Dr. Pfister is an outstanding interventionalist, who brings a warm bedside manner to his interactions. He is the “whole package,” providing both technical savvy as well as kindness. As a patient, I could not ask for more.
I.S.I’ve been a pt of Dr. Pfisters for over 10yrs, during which time he has performed 5+ procedures. As a medical professional myself, I have an exceptionally high expectation of the quality of care I receive, as well…and JUST AS IMPORTANT…the attitude and respect my Dr’s and healthcare team provide! Dr. Pfister and the staff on his team get AA+++ from me!!!!! He is kind, respectful, informative AND an EXCEPTIONALLY skilled interventional radiologist!!! I won’t EVER trust anyone else!!!
P.R.From the time I first spoke to Maryanne who was so kind, and walked thru your doors with friendly smiles to greet me – meeting Patty who was so kind and caring and meeting Dr. Love – great bedside manner and smile and made sure all my questions were answered – and having the port placed with an excellent team – Paul asking me what my hobbies were first thing – I knew I was in the right place! Thank you all, you all are amazing!
AnonymousOne of our best medical experiences during our entire cancer treatment. Thanks so much for everything!
AnonymousThis is for Dr. Pfister. I just wanted to thank him for all the time he spent with us the other week. In all the years I’ve had my vascular problems I’ve never had a doctor really sit down and explain to me the intricacies of what might be going on. I have a lot to think about…but just wanted to say thanks for being so nice and answering our many questions!
L.H.A fantastic group of wonderful people. The procedure was very smooth. When they were putting the port in I felt like I was getting a great massage!! Thank you all!
S.C.Charley was instrumental in getting me scheduled in quickly to get my PICC line removed. She actually worked until late in the day to get the information from my referring doctor’s office. It is nice to know great people like Charley still exist in this world!
K.S.I had my blood clot filter removed on 2/21/18. I was very apprehensive, yet EVERYONE in Dr. Pfister’s office and surgical team helped to make me comfortable. I am extremely claustrophobic so laying down or having something covering my face creates anxiety. Mary Anne listened to my concerns and made sure I was made comfortable and did not feel anxious. The surgical team was amazing, they explained everything thoroughly. Dr. Pfister came in after the procedure to review what he did and discuss any follow up that might be required. I so appreciate the time and attention he gives me as his patient. This was a positive experience.
G.H.110% Thank You! Best unit so far in my cancer treatment. Thanks Dr. Love
AnonymousIf you ever need an Interventional Radiologist for a child I realize it is serious business. I’ve seen Dr. Love go and save a child’s kidney without missing a beat. I could recommend no one better for myself, or for people I love. I think he is a little cool at the bedside, but that’s OK Dr. Love, stay frosty! If you can’t see Dr. Love, one of the other professionals at IVC will be able to help you. Ashley, the dynamite scheduler and one of the other surgeons at IVC will care for you. I’ve had multiple surgeries with this practice over the past several years. Never a hiccup!
S. R. – Portland, ORGreat experience, doctor was thorough in explaining what was going to happen. The nurses were very attentive and made sure I was comfortable and my needs were met. I would recommend this office for any related procedure.
AnonymousEverything went very smoothly. Joe enjoyed the music. Very friendly staff! Good Experience!
J. & E.All staff was courteous and efficient. Good experience.
J. J.Dr. Pfister, thanks so much for your excellent care, removing my chemo port earlier this week. With all your experience and your fine touch, I’m confident the scar will be nearly invisible. Your team, from beginning to end, did a super job with me. Please extend my gratitude to Jennifer, Mary Anne, Todd and Charley. I’ve got a whole lot of living left to do. I appreciate all of you helping me do it!
M. F.Dr. Pfister, thank you for all of the attention you gave to me. I learned lots from our discussion – hearing you speak of ultimate healing was enough to encourage me to do all I can to strengthen those muscles.
S. O.The entire office is one of the most professional, helpful and informative medical offices I have dealt with (and I have dealt with many). Kudos to Jennifer, Henry, and Charley!
K. C.Great people. Great place. Good surgery.
G. G.Patty, Mary Anne and the whole staff was amazing! Best experience I’ve had since being diagnosed with cancer. From start to finish, was great. Thanks.
MMy brother came into Legacy Meridian Park, had a stroke. Dr. Bauer came in immediately, in his work jeans and shirt. He worked with Neurologist Dr. Burbank, developed a plan and took my brother into a procedure where they removed the clot from his head! Very down to earth doctor, explained procedure to family, worked with sense of urgency.
J. P.I want to comment regarding Dr. Bauer of how he was thorough explaining my CT Biopsy and showing me how on the computer he would get the tissue needed. In all the years of several surgeries I have never felt better going in to have a procedure done. His bedside manner was incredible. I wish all doctors were like Dr. Bauer. Thank you for preparing and relaxing me prior to the biopsy.
R.S. Molalla OREveryone did a superb job taking care of me and doing the procedure. Thank You All
K.S.Dr. Bauer genuinely cares about his patients and strives to make sure they understand every aspect of their treatment.
A.L.Dr. Bauer, our family wants you to know how thankful we are to you for saving G.P.’s life and bringing him back to us in normal health. Thank you over and over you are the best!
Family of G. P.
We are announcing that Interventional and Vascular Consultants will be closing as of March 10, 2023.
We would like to thank you for the trust you have given us over the years, participating in your healthcare needs has been a privilege.
To assist in a smooth transition to a new provider, you may access your records from your MyHealth account or request a copy of medical records by clicking the link below and completing the Release of Information form.
Please know that we have greatly valued our relationship with you and wish you the best.
Sincerely,
Jason Bauer, MD RVT
Michael Pfister, MD RVT
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