Transcatheter embolization of an arteriovenous malformation of the scrotum

Scrotal arteriovenous malformation: Case report

Scrotal arteriovenous malformations (AVM) are extremely rare, making them difficult and complex to diagnose, and a therapeutic challenge; few cases of this type have been reported in the literature. This article reports the case of a male patient, 12 years old, with congenital AVM and background of treatment with sclerotherapy and embolization: it was decided to perform a surgical resection, which was successful. Angiography is obligatory in arteriolar cases, and it was backed up with surgical AVM treatment, taking into account the great importance of pre-surgical embolization.

[Embolization of arteriovenous malformation of the scrotum]

The authors report a rare disease at the junction of urology and cardiovascular surgery (arteriovenous malformation (AVM) of the scrotum). The options for correction of this disease are discussed. The authors describe the complications of natural course of disease and their treatment. Treatment strategy with AVM embolization is substantiated. Postoperative regression of symptoms is emphasized. The authors concluded safety and effectiveness of interventional correction of this disease.

Angioembolization of Scrotal Arteriovenous Malformations: A Case Report and Literature Review

Arteriovenous malformations (AVMs) of the scrotum are rare lesions, usually diagnosed incidentally during the evaluation of scrotal masses or infertility. It could be presented with acute bleeding or acute pain. We are presenting a case of painless bilateral infiltrated scrotal mass (more advanced in the left side) developed dramatically over a year, no other symptoms existed. The diagnosis was made using duplex ultrasound (DUS), computed tomography arteriography (CTA), and digital subtraction angiography (DSA). Three sessions of angioembolization were performed and followed by surgical resection of the left side of the scrotum.

Successful use of Onyx® for transcatheter arterial embolization of a scrotal arteriovenous malformation refractory to traditional embolic agents

A scrotal arteriovenous malformation (AVM) is a rare condition representing an abnormal connection between the arterial and venous systems of vessels supplying the scrotum. Scrotal AVMs are usually treated via transcatheter embolization, surgical extirpation, or a combination of the two approaches. A 41-year-old man developed a life-threatening hemorrhage from a scrotal AVM. After hemodynamic stability was attained, multiple transcatheter embolization procedures were performed (over the course of several months) to eliminate blood flow through the AVM. Traditional embolic agents including microcoils, Embospheres®, and Gelfoam® were used, with only temporary reduction of blood flow through the AVM. Onyx®, a liquid embolic agent, was used successfully as an adjunct treatment to achieve blood flow cessation. Onyx® demonstrates efficacy in the treatment of scrotal AVMs, and is a viable alternative to traditional embolic agents.

Bleeding scrotal vascular lesions: interventional management with transcatheter embolization

Vascular lesions of the scrotum are uncommon; the most common among them are varicocele lesions. The other vascular lesions that may involve the scrotum are hemangioma, lymphangioma, and arteriovenous malformations, which are exceedingly rare. The imaging modalities useful in the diagnosis and management of scrotal vascular lesions are grayscale sonography, color Doppler sonography, magnetic resonance imaging, magnetic resonance angiography, and digital subtraction angiography. We present two cases of scrotal vascular lesions involving the extratesticular scrotal soft tissues. Patients presented with bleeding and were treated by radiological interventional technique. We emphasize the importance of superselective catheterization and distal embolization.

Arteriovenous malformation of scrotum causing virtual azoospermia

We report a case of surgical correction of a scrotal arteriovenous malformation (AVM) that reversed severe oligospermia. A 31-year-old man was found to have virtual azoospermia and left scrotal swelling. The left scrotal mass was diagnosed as a varicocele, but the mass did not resolve after bilateral microsurgical varicocelectomies. Postoperative pelvic arteriography revealed a scrotal AVM that was subsequently embolized. With a microsurgical approach, the mass was excised. Surgical correction of the scrotal AVM resulted in marked improvement in his semen parameters. The effect of the AVM on spermatogenesis was most likely mediated by an elevation in scrotal temperature.

Arteriovenous malformation of the penis in an infant

Arteriovenous malformations (AVMs) are common benign lesions in infancy, although they are rare in the genitourinary region. The authors report on a 2-year-old boy with a penile AVM. At presentation, there was venous dilatation and tortuosity of the prepuce without ulceration, which had been recognized at 1 year of age. Left internal iliac arteriography showed early venous filling leading to the diagnosis of AVM. Surgical excision was performed at age 2. The postoperative course was uneventful. At the 6-month follow-up, there was no evidence of recurrence. This is the first report of a penile AVM that was successfully treated by surgical excision.

Attempted induction of chronic portal venous hypertension with polyvinyl alcohol particles in swine

PURPOSE

Creation of presinusoidal chronic portal venous hypertension by means of repeated portal vein (PV) embolization was explored in an attempt to improve a porcine model of transjugular intrahepatic portosystemic shunt (TIPS) patency.

MATERIALS AND METHODS

Six microswine underwent weekly PV embolization for 5 weeks with a total of 10.4-12.6 g of polyvinyl alcohol (PVA) particles (0.149-0.250 mm in size). Portography, liver function tests, pressure measurement in the PV and inferior vena cava (IVC) before and after PV embolization, and histopathologic evaluation of the livers were performed.

RESULTS

Transhepatic portal venography performed after each embolization demonstrated diffuse PV branch occlusion in all cases. At weekly follow-up, reconstitution of flow was demonstrated in these branches; permanent occlusion of PV branches was not achieved. The mean PV pressure elevated acutely from 17.3 mm Hg +/- 0.9 to 24.5 mm Hg +/- 4.2 (P < .01) after each embolization. However, the pressure always returned to baseline on the follow-up studies 1 week later. Liver function tests were normal. Histopathologic evaluation of the liver showed, in multiple PV branches, central plugs of PVA with peripheral recanalization. The liver parenchyma was otherwise normal.

CONCLUSION

Massive embolizations of PV with PVA at weekly intervals failed to create permanent portal hypertension or induce hepatic fibrosis.

Scrotal arteriovenous malformation: case report and literature review

We report a rare case of scrotal arteriovenous malformation in an adolescent. Arteriovenous malformation of the scrotum is distinguished radiographically and histologically by numerous arterioles and thick walled veins with no intervening capillary bed. The cardinal sign is a bruit. Complete excision is recommended as definitive treatment. Preoperative angio-embolization may be helpful but it should not be relied upon for clinical resolution.

Arteriovenous malformation of scrotum: a case report

Arteriovenous malformations of the scrotum are rare. We report a case of arteriovenous malformation involving the scrotal vessels. The patient presented with painful scrotal swelling, which was mainly in the skin and the Dartos layers. Vascular lesions of the scrotum are rare. By far the most common condition is varicocele. Our patient was examined by 2 other urologists before us and no one made the diagnosis of arteriovenous malformation on clinical examination. Diagnosis was made by auscultation with the Doppler stethoscope. We suggest that the possibility of a scrotal arteriovenous malformation and hemangiomas should be entertained in patients with unilateral scrotal swelling.