Surgical Options and Risks for Thoracic AV Fistula Embolization in Elderly Patients

Surgical issues related to thoracic vertebral artery and vein embolization?

Dear Dr.
Lai,
My father has been diagnosed with a vascular embolism in the thoracic spine and is scheduled for surgery.
However, he is currently 79 years old and has been experiencing weakness in both legs.

1.
Is surgery the only treatment option? Are there any alternative treatments if surgery is not performed?
2.
If left untreated, what other complications could arise besides paralysis?
3.
What is the success rate of this minimally invasive surgery?
4.
What can we expect in terms of improvement after the surgery? Is it possible for him to return to his previous condition?
Thank you.

Pan, 40~49 year old female. Ask Date: 2012/08/27

Dr. Lai Zhaokang reply Neurosurgery

I do not fully understand the question you raised.
Are you referring to your father's thoracic arteriovenous malformation? Did the physician recommend that a neuroradiologist arrange for embolization treatment, or did the physician suggest directly performing a surgical resection of the malformation? Additionally, without seeing the patient and the imaging, it is difficult to provide you with a complete recommendation.
However, based on the information you provided, I can infer the following: 1.
If your father is experiencing neurological symptoms such as lower limb weakness, treatment is necessary.
2.
Paralysis is a serious issue that can lead to complications such as incontinence and a series of secondary complications like pressure ulcers, infections, and sepsis.
3.
The success rates of surgery or embolization should be discussed with the operating or interventional physician.
4.
If the patient already has symptoms of lower limb weakness, even with successful treatment, there will generally be some residual impairment, and rehabilitation will be required afterward.

Reply Date: 2012/08/27

More Info

When considering surgical options for thoracic arteriovenous (AV) fistula embolization in elderly patients, particularly in the case of your father who is 79 years old and experiencing lower limb weakness, several factors must be taken into account.
1. Is Surgery Necessary? Are There Alternative Treatments?
The necessity of surgery largely depends on the severity of the symptoms and the underlying condition. In cases where there is significant neurological impairment, such as lower limb weakness, surgical intervention may be warranted to prevent further complications, including paralysis. However, if the symptoms are mild and not progressively worsening, conservative management options such as physical therapy, medication for pain relief, or monitoring may be considered. Non-surgical interventions, like embolization, can sometimes alleviate symptoms without the need for more invasive procedures. It's crucial to have a thorough discussion with the treating physician to evaluate the risks and benefits of surgery versus conservative management.

2. Consequences of Not Treating the Condition:
If left untreated, the condition could lead to serious complications beyond paralysis. These may include chronic pain, loss of mobility, and potential complications such as deep vein thrombosis (DVT) due to immobility. Additionally, there could be risks of developing pressure sores, urinary incontinence, and other complications associated with prolonged immobility. The risk of systemic complications, such as infections or sepsis, may also increase if the underlying vascular issues are not addressed.

3. Success Rates of Minimally Invasive Surgery:
The success rates of minimally invasive procedures like embolization can vary based on several factors, including the patient's overall health, the complexity of the vascular malformation, and the experience of the surgical team. Generally, minimally invasive techniques tend to have lower complication rates and shorter recovery times compared to traditional open surgery. However, specific success rates should be discussed with the interventional radiologist or surgeon performing the procedure, as they can provide data based on their experience and the specific characteristics of your father's condition.

4. Post-Surgery Improvement and Recovery:
The potential for recovery after surgery largely depends on the extent of the neurological damage prior to the intervention. If the surgery is successful and the vascular issue is resolved, there may be significant improvement in symptoms. However, if there has been prolonged nerve damage, some residual weakness or impairment may persist. Rehabilitation and physical therapy will be essential components of recovery, helping to maximize functional outcomes. It’s important to set realistic expectations and understand that while some patients may regain full function, others may experience varying degrees of improvement.

In conclusion, the decision to proceed with surgery should be made collaboratively between the patient, family, and healthcare team, taking into account the risks, potential benefits, and the patient's overall health status. It is advisable to seek a second opinion if there are uncertainties regarding the treatment plan, especially considering your father's age and current health condition. Engaging in open discussions with healthcare providers about all available options will help ensure that the best course of action is taken for your father's health and well-being.

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