Spinal Vascular Malformations

Vascular malformations refer to one or more abnormal vessels which form a direct connection between arteries and veins in the absence of the blood flowing through the normal structures. When these occur in the spine, they may involve the spinal cord or its surrounding tissues within the spinal canal, the bones or tissues surrounding the spine, or a combination of any of these areas.

There are several different types of spinal vascular malformations,1 and they may be present at birth or develop later on in life, although a specific cause has yet to be determined. Different types of spinal vascular lesions are associated with different populations. Symptoms may occur due to a variety of causes, including decreased blood supply to the spine and nerves, pressure from the abnormal vessels, or hemorrhage due to rupture of the vessels.

A tube or catheter is placed into an artery in the leg, and directed into the blood vessels using x-ray guidance.

Although treatment of spinal vascular lesions may be recommended, it can be tricky. Instead, a procedure known as embolization may be recommended in lieu of or in addition to surgery. In this procedure, a tube or catheter is placed into an artery in the leg, and directed into the blood vessels using x-ray guidance - similar to the procedure known as an angiogram. Materials are then injected into the vessel to prevent the blood from supplying the lesion.

The embolization procedure from start to finish
Prior to undergoing embolization, patients are expected to sign a consent form and will have the opportunity to have questions answered. The anesthesiologist will administer medications and fluids through the use of an intravenous line (IV) into a vein in the hand or arm. He or she will also administer general anesthesia so that the patient will be completely asleep for the procedure. Blood pressure will be monitored through an A-Line, a thin flexible tube or catheter placed in an artery in your wrist. An electrocardiogram (EKG) will monitor heart rate and rhythm as well as oxygen levels. A specific type of catheter known as a Foley will be placed in the bladder to allow urine to drain.
Once the procedure is complete, the patient will be transferred from the operating room to either the Surgical Intensive Care Unit (SICU) or the Post-Anesthesia Care Unit (PACU). Here, a heart monitor will closely monitor vital signs. This machine is very sensitive and often sounds inadvertently; this is not cause for alarm. The nursing staff will assist in changing positions, but bed rest is required. Eventually, the patient can look forward to a normal diet and transfer to a room on a surgical floor. The Foley catheter will also be removed prior to leaving the bed for the first time.
Patients are expected to keep the leg that underwent surgery straight for several hours and a tube may remain in place at the puncture sight for several days. Once it is removed, the physician will apply pressure for about 20 minutes to prevent bleeding, and a device may be used to seal the puncture.
If surgery is also recommended, embolization generally takes place a few days prior. Successful completion of embolization will make surgery a less risky option, due to the reduction in blood supply to the area of the malformation.