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. 2020 Jun 25;13(2):176-179.
doi: 10.3400/avd.cr.19-00111.

Spinal Cord Infarction after Transcatheter Embolization of Pelvic Arteriovenous Malformation

Shinji Wada  1 , Yukihisa Ogawa  1 , Kotaro Hosoi  1 , Kazuki Hashimoto  1 , Junji Moriya  1 , Shingo Hamaguchi  1 , Hidemichi Ito  2 , Homare Nakamura  3 , Hidefumi Mimura  1
Affiliations

Spinal Cord Infarction after Transcatheter Embolization of Pelvic Arteriovenous Malformation

Shinji Wada et al. Ann Vasc Dis. .

Abstract

An 80-year-old woman presented with abdominal and right lower limb pain. Radiological examination revealed pelvic arteriovenous malformations (pAVMs). Although transarterial embolization was repeated, dilation of the common iliac vein worsened. Four sessions of embolization were performed for the internal iliac vein. Paraplegia gradually occurred a day after the final procedure. Magnetic resonance imaging revealed thoracic spinal cord edema and paraspinal vasodilatation, suggesting spinal cord infarction. Additional angiography revealed a radiculomedullary vein draining into the spinal canal from the pAVM; hence, surgical interruption was performed. Incomplete venous embolization of the pAVM caused spinal cord congestion and infarction.

Keywords: embolization; pelvic arteriovenous malformation; spinal cord infarction.

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Conflict of interest statement

Disclosure StatementHidefumi Mimura received research grants from Nihon Medi-Physics Co.,Ltd., Fuji Pharma Co.,Ltd., FUJIFILM Toyama Chemical Co., Ltd. and Eisai Co., Ltd.; Other authors have no conflict of interest.

Figures

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Fig. 1 (a, b) Arterial and venous phase angiography before transvenous embolization after arterial embolization showing pelvic arteriovenous malformations with the right iliac venous pouch increasing in size. (c) Right internal iliac arteriography showing shunting of multiple arterioles to the initial part of the single venous component. (d) Pelvic radiograph after transvenous coil embolization shows showing coils and n-butyl 2-cyanoacrylate-lipiodol in the right internal iliac vein and previously placed coils in the branches of the right iliac arteries. (e, f, g) Late arterial and venous phases of arteriography showing residual arteriovenous malformations. We did not notice a reflux vein into the spinal canal at that time (arrow).
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Fig. 2 (a) Thoracic vertebral magnetic resonance imaging (T2-weighted image) right after the development of paraplegia showing high signal intensity in the thoracic spinal cord and fine vasodilatations around the spinal cord. (b, c) Median sacral arteriography after the development of paraplegia depicting the reflux vein ascending in the spinal canal (arrows). (d) An intraoperative finding of surgical interruption of the intradural draining vein (arrow). (e) Thoracic vertebral magnetic resonance imaging after surgical interruption of the intradural draining vein. The high signal intensity of the thoracic spinal cord and vasodilatation around the spinal cord have disappeared.
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Fig. 3 (a) Right anterior oblique view of maximum intensity projection in computed tomography (CT) angiography showing pelvic arteriovenous malformations before treatment. A vein ascending from the right internal iliac vein is observed. (b) A schema that shows the relationship between pelvic arteriovenous malformation and a drainage vein (DV) into spinal canal. Multiple feeders from the right internal iliac artery (IIA) and its branches shunt into the right internal iliac vein (IIV). The involvement of the right 4th lumber artery (LA) and the median sacral artery (MSA) was also observed. A DV ascending from right IIV near the right sacral wall was observed. (c, d, e, f) Axial images of CT angiography showing a fine vasodilatation in the lumbar spinal canal, which continues to the expanded right internal iliac vein.
See this image and copyright information in PMC

References

    1. Chen CK, Haskal ZJ, Jensen ME. Paraplegia and myelopathy due to caval thrombosis and pelvic arteriovenous malformation, reversed by embolization. J Vasc Interv Radiol 2019; 30: 118-20.e1. - PubMed
    1. Mohimen A, Kumar KS, Jayadevan ER, et al. Spinal venous hypertension secondary to pelvic extra-spinal arteriovenous fistula: a previously unreported cause of congestive myelopathy. Spine J 2016; 16: e41-2. - PubMed
    1. Cho SK, Do YS, Shin SW, et al. Arteriovenous malformations of body and extremities: analysis of therapeutic outcomes and approaches according to a modified angiographic classification. J Endovasc Ther 2006; 13: 527-38. - PubMed
    1. Kuwayama N, Akioka N, Kashiwazaki D, et al. Front line of the treatment for dural arteriovenous fistulas. Jpn J Neurosurg (Tokyo) 2016; 26: 125-33. (In Japanese)
    1. Afshar JKB, Doppman JL, Oldfield EH. Surgical interruption of intradural draining vein as curative treatment of spinal dural arteriovenous fistulas. J Neurosurg 1995; 82: 196-200. - PubMed