At Sydney AVM we are always ready and willing to organize a consultation with you and your family.
We consider it our duty to patients to make sure they receive all the information they need, that they have their questions answered, and their concerns addressed. By being fully informed about your condition and your treatment, you can take control of a confronting situation and make decisions about what treatment you want based on your individual needs in life. You will always get a recommendation from us that takes into account your individual circumstances.
Please bring you’re a family member or loved one with you for your consultation, so they can ask questions you might forget or not think of, and so they are better able to support you throughout your treatment. You don’t have to face your condition alone – you have your family and loved ones, your GP, and us at Sydney AVM to support you through your journey.
Pre-operative care is essential to getting the best outcome for you. This involves detailed consultation and getting the best imaging possible – including in many cases the need to get a high-quality cerebral angiogram performed by Dr Bhatia. In addition, some endovascular treatments require the use of tablet blood-thinners starting 5-7 days prior to your procedure and continuing for several months afterwards. We can help you to co-ordinate these medications and ensure you have the correct scripts and information.
Post-operative care is also essential in avoiding complications and making a strong recovery. This includes in-hospital care to make sure we minimize the bleeding risk from your wrist or thigh, optimizing your medications to prevent clot formation, and giving you the right advice before you leave the hospital. After you get home, we want you to know what you can expect over the coming days to weeks, how we will follow you up, and how to contact us with any concerns or questions.
Appointments
CONSULTATIONS
At Sydney AVM our initial consultations are 30 minutes long to make sure we have plenty of time to find out what your journey so far has been like, to review your imaging with you and your family, perform risk assessments, discuss treatment options, and answer all your questions. If you ever find you need more time to think or want to ask more questions, we encourage you to have time to think about your concerns, to write them down, and to come back and see us again.
Follow-up consultations after your treatment will range from 15 – 30 minutes depending on how you are doing and the type of treatment you had. Many times, if you are doing well and your follow-up MRI is stable, you may not have many questions to ask us but we are happy to receive any that you do have.
At our consultations at Sydney AVM you can expect:
- Dr Bhatia will listen to you to learn about how your condition is affecting you
- He will ask you questions to help assess your individual risks
- He will examine the functions of your brain, spinal cord, and nerves to see what effect your condition is having on you
- He will review your imaging with you live on a screen – usually with an iPad that you can hold on to and look at whilst he scrolls through your images mirrored on his computer – so you can see everything in detail and ask questions as you go
- A discussion of treatment options and their various pros and cons
- A recommendation on treatment based on Dr Bhatia’s opinion
- Time to ask any questions you or your loved ones have
- The ability to make appointments for any family members who would like to discuss the option of screening for brain aneurysms if appropriate
- A detailed individual risk assessment for your condition using the PHASES and UIATS scoring systems for brain aneurysms
WHAT TO BRING TO THE FIRST APPOINTMENT
- A referral letter from your GP or referring specialist outlining your medical history and the condition you would like to discuss with Dr Bhatia (your GP can e-mail or fax this directly to us also). If you are seeking advice on a vascular malformation, carotid artery disease, or a brain aneurysm – please also ask your GP to request from us an ultrasound of the malformation or the carotid arteries in the neck which we can do on-site for you in our rooms.
- A copy of any scans you have (CT, MRI, ultrasound). Where possible, please let our reception staff know when you make your booking where your scans were done, so Dr Bhatia can try to get electronic access to them – the original electronic images provide a greater level of detail.
- A list of questions you want answered – its easy to forget during a consultation – but don’t worry if you do – you can always see us again or drop us an e-mail.
- If you can – a family member or loved one to support you.
Fees & Billings
- Initial consultation
- Follow-up consultation
- MRI’s
- Cerebral angiography
- Endovascular treatment
You can expect to pay a total cost of $200 - $300 on the day, depending on the complexity of your case, and you can then seek reimbursement of approximately $110 from your health fund or approximately $90 from Medicare.
Please chat to our reception staff if you have any concerns about payment. In certain circumstances a no-gap arrangement may be available. The most important thing to us is to make sure you get high-quality care.
For a follow-up consultation, which are shorter than initial consults, you can expect to pay $150 - $250 on the day – depending on the length and complexity of your situation. Your health insurance company will then reimburse you approximately $50 in most cases or Medicare will reimburse approximately $40.
Again, please chat to our reception staff if you have any concerns about payment – don’t avoid follow-up because of financial distress. Your long-term health and care are important to us.
It is common for us to organize MRI scans for our patients for initial assessment or follow-up. We refer all our MRI scans to St Vincent’s Public Hospital if you live in Sydney, because we know we can rely on the quality of imaging and the standard of reporting.
For the assessment of your condition, Dr Bhatia will often need to organize a cerebral angiogram for you, to be performed by Dr Bhatia as a day procedure at St Vincent’s Private Hospital. Your insurance company will cover most of the cost of the procedure, with a small gap to pay to Sydney AVM and to the anaesthetist. This is usually in the order of several hundred dollars. For children, Dr Bhatia will perform all cerebral angiograms at the Children’s Hospital at Westmead.
You will receive an informed financial consent from Sydney AVM before your angiogram to ensure you are aware and happy with the costs involved before you proceed.
If you do not have health insurance, you can choose to pay out of pocket for the procedure at St Vincent’s Private Hospital or we can also arrange to perform your procedure at St Vincent’s Public Hospital. St Vincent’s Public Hospital is a teaching hospital, so it is Dr Bhatia's duty as a senior doctor to teach radiology trainees during your procedure and allow them to participate in your case. However, Dr Bhatia will always be present to supervise.
As with cerebral angiography, you will receive a detailed informed financial consent from Sydney AVM before your treatment to ensure you are aware and happy with costs involved. Your health insurance company will usually reimburse approximately three quarters of the cost of the procedure for most of the treatments we offer. You will also receive a small gap fee from your anaesthetist.
In some instances, we may elect to undertake your procedure at Macquarie University Hospital or Westmead Private Hospital, because of different equipment that is available there – we will inform you of this well ahead of time if we think this applies to you.
For children, we undertake all procedures at the Children’s Hospital at Westmead, and your child will be cared for in the paediatric ICU, Close Observation Unit, or in one of our other wards afterwards depending on the nature of the procedure.
Interstate & Overseas Patients
Sydney AVM welcomes patients from interstate and overseas, subject of course to any COVID restrictions that are in place. We are happy to undertake TeleHealth consultations pre-operatively and post-operatively to minimize the number of trips you need to make to Sydney. Your radiology studies may have been performed where you live – please liaise with us so we can view your imaging electronically on-line or in some cases via DropBox as required.
If you have a complex brain aneurysm, brain AVM, dural fistula, or other vascular malformation, and you want the advice and skills of a true expert in the field – we are here to support you and offer you the highest level of treatment available.
BILLING
Some overseas patients will pay for their hospital stay and treatment out of their own pocket, whilst others will have an appropriate overseas health fund willing to pay for their treatment. Please contact our staff for an estimate of costs.
ACCOMMODATION
For a list of local accommodation available near St Vincent’s Private Hospital, please use this link:
https://www.svphs.org.au/patients-visitors/visiting/accommodation-for-visitors
For information on accommodation near the Children’s Hospital at Westmead, please use this link:
https://www.schn.health.nsw.gov.au/visiting-and-staying/inpatient-handbook/childrens-hospital-westmead/accomodation-parents
Family Screening
Brain aneurysms are more common in relatives of people with a brain aneurysm compared with the rest of the population. 10-20% of first-degree relatives (parents, siblings, children) of people with a brain aneurysm will also develop an aneurysm. That risk is higher in women, smokers, and people with high blood pressure.
Screening is a process where we perform a test (most often MRI) to look for a brain aneurysm, even if you have no symptoms, based on your family history. Screening is not for everyone – some people would prefer to know if they have an aneurysm whilst others would prefer not to know. It is easier to make this decision after undergoing a consultation with us at Sydney AVM where we can discuss your overall risk of having an aneurysm, and the positives and negatives of screening.
- If two first-degree relatives have brain aneurysms, the recommendation is that all other first-degree relatives should consider screening with MRI.
- If you have one first-degree relative who has had a brain aneurysm, you can consider screening after having a consultation with us. It is reasonable to undergo screening when you have a family history, but you should be aware of the advantages and disadvantages of screening before you have a scan.
- After consulting with Sydney AVM, if you have decided you would like to undergo screening, we will organise an MRI for you at St Vincent’s Public Hospital, where the MRI department has expertise in the best imaging protocol for aneurysm detection – designed in conjunction with Dr Bhatia who also works in the same department. Dr Bhatia will then personally go through the results with you at the next consultation.
If you live far from Sydney, we can arrange for the initial MRI to be performed at a radiology practise closer to you. Tele-Health consultations can be organized on request, but where possible Dr Bhatia prefers to be able to communicate with you directly and in person.