Arteriovenous Fistula Embolization in Suspected Parauterine Choriocarcinoma

Alturkistani, Husain; Almarzooqi, Mohamed-Karji; Oliva, Vincent L.; Gilbert, Patricia

doi:10.1155/2016/6353471

Cited by 1 publication

(2 citation statements)

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“…AVFs following gestational choriocarcinoma, treated with embolization (Alturkistani et al, 2016) or conservatively (Kim et al, 2013), were previously described. In the present case, a young woman symptomatic for metrorrhagia but without chest pain or dyspnea was admitted to our institute.…”

Section: Discussionmentioning

confidence: 99%

“…Myometrium and vascular invasion are typical features, resulting in spread to distant sites, most commonly to the lungs (Mangili et al, 2014). It affects one in 40 000 pregnancies and one in 40 hydatidiform moles and can determine massive uterine bleeding and arterio-venous fistula (AVF), in selected cases treated with transcatheter embolization (Alturkistani et al, 2016; Wang et al, 2017). Choriocarcinoma-associated pulmonary thromboembolism represents another complication (Zhu et al, 2016) and thrombolysis a potential therapeutic option (Yang & Peng, 2017).…”

Section: Introductionmentioning

confidence: 99%

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A rare case of a giant arterio-venous fistula (AVF) following metastatic choriocarcinoma conditioning pulmonary embolism: multimodal transcatheter embolization using a simultaneous transarterial and transvenous approach

et al. 2018

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BackgroundChoriocarcinoma is a highly malignant tumor but with a good prognosis due to the valid response to systemic chemotherapy. We present a case of a young woman affected by a giant pelvic arterio-venous fistula following a metastatic gestational choriocarcinoma, conditioning metrorrhagia and pulmonary embolism, successfully treated by multimodal transcatheter embolization, using a simultaneous transarterial and transvenous approach.Case presentationIn a young patient affected by choriocarcinoma and metrorrhagia, a computed tomography showed a giant arterio-venous fistula, pulmonary metastases and embolism. A transfemoral diagnostic arteriography showed a giant arterio-venous fistula sustained by right and left hypogastric arteries with early opacification of the right gonadal vein and of the inferior vena cava. A transarterial embolization of the distal branches of hypogastric arteries with poly-vinyl-alcohol particles, coils and Squid was performed. A transfemoral phlebography of the right gonadal vein showed multiple thrombi, responsible of the pulmonary embolism. An Amplatzer plug via trans-jugular was finally placed at the confluence of the gonadal vein in the vena cava, to reduce arterio-venous fistula out-flow and to occlude the vein, preventing further episodes of pulmonary embolism. Metrorrhagia progressively disappeared. A second transarterial embolization combined with a complete response to systemic chemotherapy determined arterio-venous fistula resolution.ConclusionsThis was a very rare case of a giant pelvic arterio-venous fistula following choriocarcinoma in a patient symptomatic for metrorrhagia with an accidental finding of pulmonary embolism at computed tomography. A transcatheter embolization was successfully performed with different embolic materials, using a simultaneous transarterial and transvenous approach: the goal was not only to obtain metrorrhagia resolution but also to avoid a massive pulmonary embolism, a potential life threatening condition, in a young woman affected by a highly malignant tumor but with a good prognosis.

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Section: Discussionmentioning

confidence: 99%