VS08. Endovascular Aortobiiliac “Bypass” for Juxtarenal Aortobiiliac Occlusive Disease

Abstract

Objectives: Pelvic arteriovenous malformations (AVMs) are rare, complex clinical entities that often require a multifaceted approach to treatment. Surgical ligation of proximal feeding vessels has historically been shown to result in recurrence, and thus endovascular embolization is now the mainstay of treatment. The purpose of this study was to review the outcomes of a large series of patients with pelvic AVMs managed using a variety of endovascular techniques.Methods: We retrospectively reviewed all patients with high-flow pelvic AVMs treated at our institution from January 2005 to December 2015. Patient-related data were collected with regard to patient demographics, comorbidities, and presenting symptoms. Procedural and anatomic information, including embolization agent and vessel(s) treated, was collected, as well as follow-up data regarding number of treatments required and resolution of symptoms.Results: A total of 30 patients, 17 female (56.6%), with a mean age of 52.1 years (range, 28-89 years), underwent treatment for pelvic AVMs at our institution. Presenting symptoms included pelvic pain and discomfort in 25 patients (83.3%), bleeding in 8 (26.7%), high output cardiac failure in 7 (23.3%), mass effect in 5 (16.7%), and hematuria in 3 (10%). A total of 121 procedures were performed, with a mean of four procedures per patient (range, 1-13 procedures). Multiple procedures were performed in 23 patients (76.7%), 10 (33.3%) of which were planned as staged embolizations. The most common vessels involved were branches of the hypogastric artery in 27 patients (90.8%). Other vessels included inferior mesenteric artery branches in 6 patients (30%), median sacral artery in 3 (10%), and gonadal artery in 2 (6.7%). Multiple arteries were involved in Author Disclosures: Z. Cheema: Nothing to disclose; C. Cheng: W. L. Gore: other financial or material support; G. Fankhauser: Nothing to disclose; M. Silva: Nothing to disclose; J. Worsham: Nothing to disclose.