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Case Reports
. 2014 Jun 6:2014:bcr2013203492.
doi: 10.1136/bcr-2013-203492.

Pelvic arteriovenous malformation treated by transarterial glue embolisation combining proximal balloon occlusion and devascularisation of multiple feeding arteries

Kenji Murakami  1 , Takayuki Yamada  1 , Reiko Kumano  1 , Yasuo Nakajima  1
Affiliations
Case Reports

Pelvic arteriovenous malformation treated by transarterial glue embolisation combining proximal balloon occlusion and devascularisation of multiple feeding arteries

Kenji Murakami et al. BMJ Case Rep. .

Abstract

We present a case of a 70-year-old man with abdominal aortic aneurysm and coincident pelvic arteriovenous malformation (AVM). Before the operation for the aneurysm, we embolised the pelvic AVM that had multiple feeding arteries and an aneurysmal-dilated draining vein. After decreasing the number of the feeding arteries by coil embolisation, an n-butyl-2-cyanoacrylate/lipiodol mixture (1:1) was injected into the prominent feeding artery and nidus with proximal balloon occlusion of the right internal iliac artery to decrease the flow to the nidus. The mixture (1:4-8) was also added for the finer feeding arteries that became apparent after the initial procedure to embolise the rest of the nidus. A follow-up study showed no contrast enhancement of the nidus and aneurysmal draining vein.

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Figures

Figure 1
Figure 1
CT scan demonstrating the nidus of pelvic arteriovenous malformation (arrow) and aneurysmal-dilated vein adjacent to the urinary bladder.
Figure 2
Figure 2
Angiography showed some feeding arteries from the right internal iliac artery, nidus (arrow) and a single draining vein (arrow head) to the right internal iliac vein.
Figure 3
Figure 3
(Left) We embolised the superior and inferior glutaeal arteries and the iliolumbar artery by microcoils to decrease the number of feeding arteries (arrow:coil). (Right) The rest of the nidus was still perfused through other feeding arteries, which became apparent after the embolisation.
Figure 4
Figure 4
Right common iliac arteriogram showing complete obliteration of the nidus and aneurysmal-dilated vein.
Figure 5
Figure 5
Follow-up CT scans (1 year and 5 months) demonstrating the nidus which was partly filled with the mixture (arrow) but did not show contrast enhancement in the rest of the nidus.
See this image and copyright information in PMC

References

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