Symptomatic Pelvic Arteriovenous Malformation Treated Successfully With an Endovascular Approach

Endovascular management of a pelvic arteriovenous malformation

“…An initial concern with a stepwise endovascular approach as detailed in this case report would be the necessity of multiple operative sessions to achieve complete obliteration of the aneurysm sac. This contrasts with previously published case reports that utilize a single endovascular procedure to embolize both arterial inflow and venous outflow of the AVM, 4 , 5 , 9 , 12 as well as any open procedures that ligates the AVM and all collateral branches. 7 , 11 , 13 , 14 Nonetheless, this step-wise approach allowed for a more conservative treatment plan, because we could be ensured that all arterial collateral vasculature was embolized before closing off outflow venous structures.…”

“… 7 , 11 , 13 , 14 These contrasts starkly with endovascular treatment, as follow-up outpatient visits and subsequent imaging studies may be required to ensure and reconfirm complete elimination of arterial flow and shrinking of saccular structure. 4 , 5 , 9 , 12 We postulate that even though endovascular treatment should be considered as high valued care for treatment of aneurysms of this type, this approach may not be the best option for acutely symptomatic or ruptured aneurysms with intraperitoneal bleeding of unknown origin.…”

“…Although surgical ligation of feeding arteries or excision of aneurysmal tissue around or within the AVM is an option, the preferred method of treatment of aneurysmal pelvic AVMs has been through endovascular coil embolization, with both venous and arterial embolization occurring in a single procedure. 4 , 5 , 9 , 12 However, in this case study, we describe the incidental finding of a pelvic AVM that was treated with staged arterial and venous coil embolization. These staged procedures resulted in complete resolution of the aneurysmal flow on follow-up imaging, while preventing any possible rupture owing to remaining collateral arterial flow in a concomitant arterial and venous embolization procedure.…”