Arteriovenous Fistula

What are Arteriovenous fistulas (AVFs)?

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Arteriovenous fistulas are abnormal connections between blood vessels in the coverings of the brain.

Although some rare AVFs appear in newborns, this type of abnormality typically develops as people grow older and is not considered hereditary (passed on through families) or congenital (present at birth).

Why rely on Washington University experts for AVF treatment?

Washington University cerebrovascular surgeons work as part of a multidisciplinary team to offer treatment for arteriovenous fistulas at the Barnes-Jewish Hospital Stroke and Cerebrovascular Center. 

  • The center is among the most experienced in managing brain vascular malformations and receives physician referrals from across the country. 
  • Because of our expertise, minimally invasive techniques are often used for the treatment of AVFs.
  • Intraoperative angiography is routinely used to confirm effectiveness of AVF treatment at time of surgery

In addition to cerebrovascular surgeons, other physician members of the treatment team include neurologists who specialize in interventional radiology; critical care and neuro-rehabilitation neurologists; and radiation oncologists, who perform Gamma Knife radiosurgery.


The type of treatment depends on the AVF’s location, presence or absence of cortical venous drainage (CVD), severity and nature of symptoms, the patient’s age and health status, and the risk involved in treatment. AVFs are treated on a case-by-case basis. Treatment options include:


When a patient has an AVF without cortical venous drainage (CVD), observation is often the appropriate choice. It may also be appropriate for select patients who have an AVF with CVD, including those who are older, have multiple medical problems or have a complex AVF for which treatment carries high risk.

Endovascular Embolization 

This inpatient procedure entails passing a small catheter (tube) from a blood vessel in the groin (or arm) up into the AVF, where glue or other material is injected. For many patients, this cures the AVF; in others, it is used in preparation for surgery or radiosurgery. If successful, it provides immediate protection against AVF rupture.


Open surgery is an inpatient procedure designed to remove the CVD (the dangerous part of an AVF) or cure the entire AVF. If successful, the procedure provides immediate protection against AVF rupture.

Gamma Knife Radiosurgery

A one-day, less-invasive outpatient procedure that involves precisely focusing radiation beams onto the AVF, Gamma Knife radiosurgery causes the AVF to shrink over time. In many cases, the AVF will be cured 1-3 years after treatment.