Transvenous embolization for a huge pelvic arteriovenous malformation associated with prominent outflow veins

Ugajin, Atsushi; Fujii, Hiroyuki; Fujita, Akifumi; Nakamura, Hiroyasu; Fujisaki, Akira; Sugimoto, Hideharu

doi:10.1016/j.radcr.2019.12.013

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…Ugajin et al reported the atypical application of DOV occlusion in the successful management of a complex intrapelvic AVM after the patient experienced recurrence post trans‐arterial embolization with n‐butyl‐cyanoacrylate. 40 That case differed from previous reports of DOV in the malformations large size with higher risk for nontarget embolization and nidus rupture, as well as the presence of multiple draining veins. The authors of that report emphasized the importance of embolization in a proximal location adjacent to the nidus to decrease the risk of collateral venous drainage.…”

Section: Discussioncontrasting

confidence: 85%

“…Contrasted to direct compression of venous outflow in the cat of this report, Cho et al describe the use of coil and core‐removed guide wire embolization, intravascular occlusion balloons, and external pneumatic cuffs. Ugajin et al reported the atypical application of DOV occlusion in the successful management of a complex intrapelvic AVM after the patient experienced recurrence post trans‐arterial embolization with n‐butyl‐cyanoacrylate 40 . That case differed from previous reports of DOV in the malformations large size with higher risk for nontarget embolization and nidus rupture, as well as the presence of multiple draining veins.…”

Section: Discussionmentioning

confidence: 98%

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Dominant outflow vein occlusion in the management of naturally occurring peripheral arteriovenous anomalies in cats and dogs

Hyndman

Weisse

Schwartz

et al. 2021

Veterinary Internal Medicne

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Two dogs and 1 cat were referred to a tertiary veterinary center for the consultation and treatment of limb edema, variable dermal sanguineous crusting lesions, and intermittent lameness. A peripheral arteriovenous anomaly (PAA) was diagnosed via computed tomographic angiography (CTA) in each case. Arteriography enabled further evaluation of the PAA with confirmation of a dominant outflow vein. Dominant outflow vein occlusion was achieved by direct ligation in 1 dog and retrograde transvenous glue embolization in the cat and other dog. Repeat arteriography demonstrated resolution of arteriovenous shunting. Presenting clinical signs resolved in all animals. The previously identified aberrant vessels in 1 dog were not identified after CTA 40 days postoperatively. No postoperative complications or recurrence was identified in any case during the 6‐ to 55‐month follow‐up period.

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Section: Discussioncontrasting

confidence: 85%

Section: Discussionmentioning

confidence: 98%

Dominant outflow vein occlusion in the management of naturally occurring peripheral arteriovenous anomalies in cats and dogs

Hyndman

Weisse

Schwartz

et al. 2021

Veterinary Internal Medicne

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“…Extracranial AVMs are frequently treated with multiple embolizations; however, given high rates of recurrence, radiation treatment may be considered [5]. Successful management of pelvic AVMs with embolizations has been reported in a number of series [15][16][17][18][19][20][21][22][23]. Furthermore, a recent systematic review has highlighted the evidence behind the use of stereotactic radiosurgery and fractionated radiotherapy for the management of spinal AVMs, including intramedullary lesions of thoracolumbar junction and conus medullaris [24].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiotherapy (SBRT) for an Extracranial Arteriovenous Malformation of the Pelvis

Jooya¹,

Simons²,

Tsang³

2021

Cureus

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Extracranial arteriovenous malformations (AVMs) are rare pathological, benign conditions that are characterized by aberrantly connected arteries and veins without normal intervening capillary vasculature. Although stereotactic radiosurgery is an established, efficacious, safe treatment for intracranial AVMs, there is no known published data on the use of stereotactic body radiotherapy (SBRT) for the treatment of abdominopelvic AVMs.One patient with an extracranial AVM in the pelvis that was only partially responsive to embolization was treated with SBRT to a dose of 21 Gy, delivered in three fractions over six calendar days.At presentation, the patient was non-ambulatory due to neuropathic pain from a sciatic impingement of the AVM. The patient underwent two prior catheter-based embolization procedures that had achieved partial obliteration, but with the persistence of neuropathic pain and symptoms. After SBRT to the pelvic AVM, the patient had marked improvement in pain over 10 months and was able to ambulate again. Follow-up angiography and CT demonstrated the obliteration of previously visualized AVM.We describe the first known report of pelvic AVM successfully treated with a combination of embolization and SBRT. Three-fraction SBRT to a total dose of 21 Gy appears to be safe and effective for extracranial AVMs arising in the pelvis. This strategy may be considered for patients with pelvic AVMs that are refractory to standard interventional therapies. However, these findings should be validated in larger cohorts.

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“…4 Although the usual target for embolization is the nutrient artery or nidus itself, recently successful treatment has been achieved with embolization of the draining vein. [29][30][31] Surgical excision of intraosseous AVMs offers the highest likelihood of cure; however, surgery can be quite morbid, especially in cases with extensive involvement, and may require future reconstruction of the residual defect. 11,19,32 In cases of small intraosseous AVMs, surgery alone has been successful in achieving complete resolution of symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…4 Although the usual target for embolization is the nutrient artery or nidus itself, recently successful treatment has been achieved with embolization of the draining vein. 29 -31…”

Section: Discussionmentioning

confidence: 99%

A Case of an Aggressive Intraosseous Arteriovenous Malformation in the Lower Extremity: Special Considerations for Diagnosis and Management

Stribling

Abu‐Ghname

Trost

et al. 2020

Vasc Endovascular Surg

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Background: Arteriovenous malformations (AVMs) are rare, congenital vascular anomalies. Intraosseous AVMS most frequently arise in the head and neck, with only a small fraction occurring in the extremities. Herein, we report the findings of a combined soft tissue and intraosseous AVM involving the lower extremity of a 13-year-old child. This case highlights the necessity of an interdisciplinary approach for the effective treatment and management of these rare vascular anomalies. Case Description: A 13-year-old female presented with a 4-year history of intermittent pain and swelling over her right lateral malleolus. The patient was evaluated with radiologic imaging revealing an AVM involving the right distal leg, ankle, and hindfoot with intraosseous involvement of the distal tibia and talus. She was then referred to Vascular and Plastic Surgery and an angiogram was performed demonstrating shunting from the anterior tibial, peroneal, and posterior tibial arteries to the AVM. Venous drainage was to the anterior tibial and greater saphenous veins. Three embolizations were performed over the course of 6 months. Following the third embolization, the patient was taken to the operating room where Plastic and Orthopedic Surgery performed total resection of the nidus and involved bone which was then grafted with injectable synthetic bone graft. Results: Successful resection of the nidus was achieved, and the patient had an uncomplicated recovery. Within 6 months postoperatively, the patient demonstrated full range of lower extremity motion and was able to participate in age appropriate gross motor activities. Radiologic evaluation 7 months postoperatively showed no evidence of nidus recurrence. Conclusion: Intraosseous involvement of AVMS is rare and presents a therapeutic challenge due to its invasive potential and high incidence of recurrence. Wide local excision with bone grafting and interdisciplinary management are paramount for complete resection.

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Transvenous embolization for a huge pelvic arteriovenous malformation associated with prominent outflow veins

Cited by 7 publications

References 9 publications

Dominant outflow vein occlusion in the management of naturally occurring peripheral arteriovenous anomalies in cats and dogs

Dominant outflow vein occlusion in the management of naturally occurring peripheral arteriovenous anomalies in cats and dogs

Stereotactic Body Radiotherapy (SBRT) for an Extracranial Arteriovenous Malformation of the Pelvis

A Case of an Aggressive Intraosseous Arteriovenous Malformation in the Lower Extremity: Special Considerations for Diagnosis and Management

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