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Ethanol embolotherapy of pelvic arteriovenous malformations: an initial experience.

Bae S, Do YS, Shin SW, Park KB, Kim DI, Kim YW, Cho SK, Choo SW, Choo IW - Korean J Radiol (2008 Mar-Apr)

Bottom Line: The therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms, as well as the degree of devascularization observed on post-procedural angiography.Seven (88%) of eight patients were cured of their AVMs and one patient (12%) displayed improvement.Major complications were seen in two patients (25%).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Objective: We retrospectively assessed the results of performing ethanol embolization for pelvis arteriovenous malformations (AVMs).

Materials and methods: During the past 10 years, eight patients (8 females, age range: 27-52 years) with AVMs in the pelvic wall (n = 3) and uterus (n = 5) underwent staged ethanol embolizations (range: 1-5, mean: 2.5) under general anesthesia. Ethanol embolization was performed by the use of the transcatheter and/or direct puncture techniques. Clinical follow-up was performed for all of the patients, and imaging follow-up was available for seven patients. The therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms, as well as the degree of devascularization observed on post-procedural angiography.

Results: During the 20 sessions of ethanol embolization, the solitary transarterial approach was used 14 times, the transvenous approach was used three times and direct puncture was used once. For two patients, the transarterial and transvenous or direct puncture approaches were used together in one session. For four patients, ethanol and coils were used as embolic agents, and n-butyl cyanoacrylate (NBCA) and ethanol were used in one patient. Seven (88%) of eight patients were cured of their AVMs and one patient (12%) displayed improvement. Major complications were seen in two patients (25%).

Conclusion: Ethanol embolization is effective for the treatment of pelvic arteriovenous malformations, though there is a chance of a major complication.

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Related in: MedlinePlus

38-year-old woman (patient 8) with uterine arteriovenous malformations that caused massive vaginal bleeding.A-C. Pretreatment posteroanterior pelvic angiogram shows large arteriovenous malformations in uterus with dilated draining veins.D. Two sessions of transarterial approach with using ethanol were not effective for managing vaginal bleeding. One session of direct puncture of uterine arteriovenous malformations and NBCA (n-butyl cyanoacrylate) embolization was performed to stop the vaginal bleeding.E. Final posteroanterior pelvic angiogram shows complete obliteration of arteriovenous malformations.
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Figure 2: 38-year-old woman (patient 8) with uterine arteriovenous malformations that caused massive vaginal bleeding.A-C. Pretreatment posteroanterior pelvic angiogram shows large arteriovenous malformations in uterus with dilated draining veins.D. Two sessions of transarterial approach with using ethanol were not effective for managing vaginal bleeding. One session of direct puncture of uterine arteriovenous malformations and NBCA (n-butyl cyanoacrylate) embolization was performed to stop the vaginal bleeding.E. Final posteroanterior pelvic angiogram shows complete obliteration of arteriovenous malformations.

Mentions: Staged ethanol embolization was performed to embolize all or part of the nidus. The routes for gaining vascular access to the nidus were chosen after performance of initial angiography. Transarterial catheterization, transvenous catheterization by using a coaxial microcatheter for the superselection of the nidus and/or direct percutaneous puncture were required to reach the nidus itself and not the vascular feeders for embolization (5). An additional balloon catheter was used to reduce proximal flow to the nidus when ethanol was injected in two sessions for two patients. Pure (99.9%) ethanol was used as an embolic agent. The amount of ethanol used was based on the amount of contrast medium required to fill the AVM nidus without opacifying the normal vessels. During the 20 sessions of ethanol embolization, the solitary transarterial approach was used 14 times, the transvenous approach was used three times and direct puncture was used once. In two patients, the transarterial and transvenous or direct puncture approaches were used together in one session (Fig. 2). In 6 sessions of four cases with multiple feeders and a dominant draining vein, coils (Nester coil; Cook, Bloomington, IN) were used to reduce the amount of required ethanol in the nidus of the AVM and to stabilize the thrombosis in the dilated outflow vein as previously reported (5). In one case, n-butyl cyanoacrylate (NBCA) was additionally used with ethanol to stop vaginal bleeding.


Ethanol embolotherapy of pelvic arteriovenous malformations: an initial experience.

Bae S, Do YS, Shin SW, Park KB, Kim DI, Kim YW, Cho SK, Choo SW, Choo IW - Korean J Radiol (2008 Mar-Apr)

38-year-old woman (patient 8) with uterine arteriovenous malformations that caused massive vaginal bleeding.A-C. Pretreatment posteroanterior pelvic angiogram shows large arteriovenous malformations in uterus with dilated draining veins.D. Two sessions of transarterial approach with using ethanol were not effective for managing vaginal bleeding. One session of direct puncture of uterine arteriovenous malformations and NBCA (n-butyl cyanoacrylate) embolization was performed to stop the vaginal bleeding.E. Final posteroanterior pelvic angiogram shows complete obliteration of arteriovenous malformations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627228&req=5

Figure 2: 38-year-old woman (patient 8) with uterine arteriovenous malformations that caused massive vaginal bleeding.A-C. Pretreatment posteroanterior pelvic angiogram shows large arteriovenous malformations in uterus with dilated draining veins.D. Two sessions of transarterial approach with using ethanol were not effective for managing vaginal bleeding. One session of direct puncture of uterine arteriovenous malformations and NBCA (n-butyl cyanoacrylate) embolization was performed to stop the vaginal bleeding.E. Final posteroanterior pelvic angiogram shows complete obliteration of arteriovenous malformations.
Mentions: Staged ethanol embolization was performed to embolize all or part of the nidus. The routes for gaining vascular access to the nidus were chosen after performance of initial angiography. Transarterial catheterization, transvenous catheterization by using a coaxial microcatheter for the superselection of the nidus and/or direct percutaneous puncture were required to reach the nidus itself and not the vascular feeders for embolization (5). An additional balloon catheter was used to reduce proximal flow to the nidus when ethanol was injected in two sessions for two patients. Pure (99.9%) ethanol was used as an embolic agent. The amount of ethanol used was based on the amount of contrast medium required to fill the AVM nidus without opacifying the normal vessels. During the 20 sessions of ethanol embolization, the solitary transarterial approach was used 14 times, the transvenous approach was used three times and direct puncture was used once. In two patients, the transarterial and transvenous or direct puncture approaches were used together in one session (Fig. 2). In 6 sessions of four cases with multiple feeders and a dominant draining vein, coils (Nester coil; Cook, Bloomington, IN) were used to reduce the amount of required ethanol in the nidus of the AVM and to stabilize the thrombosis in the dilated outflow vein as previously reported (5). In one case, n-butyl cyanoacrylate (NBCA) was additionally used with ethanol to stop vaginal bleeding.

Bottom Line: The therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms, as well as the degree of devascularization observed on post-procedural angiography.Seven (88%) of eight patients were cured of their AVMs and one patient (12%) displayed improvement.Major complications were seen in two patients (25%).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Objective: We retrospectively assessed the results of performing ethanol embolization for pelvis arteriovenous malformations (AVMs).

Materials and methods: During the past 10 years, eight patients (8 females, age range: 27-52 years) with AVMs in the pelvic wall (n = 3) and uterus (n = 5) underwent staged ethanol embolizations (range: 1-5, mean: 2.5) under general anesthesia. Ethanol embolization was performed by the use of the transcatheter and/or direct puncture techniques. Clinical follow-up was performed for all of the patients, and imaging follow-up was available for seven patients. The therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms, as well as the degree of devascularization observed on post-procedural angiography.

Results: During the 20 sessions of ethanol embolization, the solitary transarterial approach was used 14 times, the transvenous approach was used three times and direct puncture was used once. For two patients, the transarterial and transvenous or direct puncture approaches were used together in one session. For four patients, ethanol and coils were used as embolic agents, and n-butyl cyanoacrylate (NBCA) and ethanol were used in one patient. Seven (88%) of eight patients were cured of their AVMs and one patient (12%) displayed improvement. Major complications were seen in two patients (25%).

Conclusion: Ethanol embolization is effective for the treatment of pelvic arteriovenous malformations, though there is a chance of a major complication.

Show MeSH
Related in: MedlinePlus