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Gao Y, Lodh SP, Ahmadi N. Pelvic arteriovenous malformation causing per rectal haemorrhage - A case report. Int J Surg Case Rep 2024; 115:109291. [PMID: 38280343 PMCID: PMC10839948 DOI: 10.1016/j.ijscr.2024.109291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/29/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE We present the case of a 17 years old girl with per rectal haemorrhage secondary to pelvic arteriovenous malformations (AVM) and potentially haemorrhoids. Pelvic AVMs are rare and extremely variable in their clinical presentation, size and location and pose a therapeutic challenge. Focus has turned towards interventional radiological procedures with angioembolisation as the main treatment form for pelvic AVMs. CASE PRESENTATION A 17 years old girl presented to a rural hospital with significant per rectal bleeding requiring transfer to a tertiary centre with interventional radiology capabilities. Diagnostic imaging determined the presence of a pelvic AVM as well as haemorrhoid. She had no prior history of haemorrhoids, per rectal bleeding or per vaginal bleeding. Further diagnostic imaging including a digital subtraction angiography and MRI pelvis was performed and her case was discussed at a multidisciplinary meeting where the decision was made for angioembolisation of a large right rectal AVM as well as precautionary banding of haemorrhoids that had developed secondary to outflow obstruction. A repeat CT mesenteric angiogram a month later demonstrated diminished appearances of the rectal AVM. CLINICAL DISCUSSION Pelvic AVMs are a rare entity and are not a common cause for per rectal bleeding. There is currently no direct consensus on the optimum management of complex pelvic AVMs particularly those that present with a second pathology such as haemorrhoids. Surgical management often results in recurrence or rapid progression of the AVM lesion and recruitment of new blood supply further complicates the problem. Selective embolisation allows for control of haemorrhage and utilises chemical agents as well as detachable coils and balloons. However, postoperative pain and swelling can still be expected and multiple transcatheter embolisations may be required. CONCLUSION The treatment of symptomatic pelvic AVMs is complex and requires a multidisciplinary approach with careful radiological planning prior to embolisation. Angioembolisation is becoming increasingly prevalent and multiple embolisation procedures may be required to reach the desired therapeutic effect.
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Affiliation(s)
- Yijun Gao
- St George Peritonectomy Unit, St George Public Hospital, Sydney, NSW 2217, Australia; University of New South Wales, St George & Sutherland Clinical School, Sydney, NSW 2217, Australia.
| | - Suhrid P Lodh
- St George Peritonectomy Unit, St George Public Hospital, Sydney, NSW 2217, Australia
| | - Nima Ahmadi
- St George Peritonectomy Unit, St George Public Hospital, Sydney, NSW 2217, Australia
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2
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Szmygin M, Giurazza F, Marini PD, Jargiełło T, Pyra K. Pelvic AVM Embolization: A Tricky Affair-Multicenter Retrospective Experience. J Endovasc Ther 2024:15266028231221977. [PMID: 38178592 DOI: 10.1177/15266028231221977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
PURPOSE Pelvic arteriovenous malformations (pAVMs) are congenital or acquired vascular anomalies, presenting with hematuria, menometrorrhagia, pelvic pain, and varices; they can be life-threatening in case of rupture. Surgical therapies have been proposed but endovascular embolization has been recognized as the primary modality. The aim of this article was to report a retrospective multicenter experience concerning embolization of pelvic AVMs and provide literature overview. MATERIALS AND METHODS We describe 18 patients (14 female and 4 male) diagnosed with pAVM and treated with minimally invasive methods. The pre-procedural imaging evaluation was based on transpelvic and/or transvaginal color Doppler ultrasound, contrast-enhanced computed tomography, and/or magnetic resonance. In 3 cases, the malformation was congenital and in other 15, acquired. Most common symptoms were menometrorrhagia, hematuria, pelvic pain and pressure, and heaviness in the lower abdominal region. In 10 cases (56%), only 1 procedure was required. Eight patients underwent multistage treatment. RESULTS Complete occlusion of the lesion in post-procedural angiography was observed in 12 patients (67%). No major periprocedural complications were observed. In 14 cases (78%), both satisfactory embolization and significant clinical improvement was achieved in long-term follow-up. Sixteen patients (88%) were at least satisfied with the clinical outcome. One patient reported subsequent successful pregnancy 5 years after the treatment. CONCLUSION Hemodynamics of pAVM are variable and thorough understanding of the vessel anatomy is crucial in planning and choosing proper treatment. Both transarterial and percutaneous direct puncture embolization strategies appear safe, technically feasible, and clinically effective. CLINICAL IMPACT In this manuscript, we discuss the role of interventional radiology methods in the treatment of pelvic arteriovenous malformations along with its advantages, limitations and possible complications. In addition to this, we review the current literature and confront our findings with those made by other authors. We believe that modern endovascular methods offer safe and reliable alternative for traditional surgical therapy and should be therefore considered during multidisciplinary treatment of these patients.
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Affiliation(s)
- Maciej Szmygin
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Francesco Giurazza
- Department of Interventional Radiology, Cardarelli Hospital, Naples, Italy
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Pyra
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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3
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Anton Sagayanathan P, Goai XY, Stephens D, Pridgeon S. Congenital periprostatic pelvic arteriovenous malformation presenting as isolated pelvic pain and requiring endovascular embolization. ANZ J Surg 2023. [PMID: 36732894 DOI: 10.1111/ans.18308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 12/28/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Affiliation(s)
- Prasanth Anton Sagayanathan
- Department of Urology, Mackay Base Hospital, Mackay, Queensland, Australia.,Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Xin Yi Goai
- Department of Urology, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Daryl Stephens
- Department of Urology, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Simon Pridgeon
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia.,School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.,Australian Clinical Trials and Research, Cairns, Australia
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4
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Endovascular Management of a Pelvic Arteriovenous Malformation. J Vasc Surg Cases Innov Tech 2022; 8:736-739. [DOI: 10.1016/j.jvscit.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
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Li X, Li J, Wang M, Wang J, Wang L, He H, Li M, Li Q, Shu C. Case Report: A Rare Abdominopelvic Arteriovenous Malformation: Originating From Splenic Artery and Draining Into Portal Vein. Front Cardiovasc Med 2022; 9:916096. [PMID: 35811714 PMCID: PMC9260105 DOI: 10.3389/fcvm.2022.916096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAbdominopelvic arteriovenous malformation is an uncommon congenital vascular lesion, for which the diagnosis and treatment are usually difficult. Though embolization and sclerotherapy are the primary treatment strategies, traditional surgical resection remains a valuable option.Case PresentationHerein, we present a 32-year-old female diagnosed with a massive abdominopelvic arteriovenous malformation that originates from the splenic artery and drains into the portal vein. The vascular lesion was evaluated with multiple imaging modalities and then surgically resected successfully. The patient was discharged post-operatively on day 6 and free of symptoms during the 12-month follow-up.ConclusionTo our knowledge, the presented abdominopelvic arteriovenous malformation is the first to be reported in the literature, with such a rare condition originating from the splenic artery and draining into the portal vein.
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Affiliation(s)
- Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jiehua Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mo Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Junwei Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lunchang Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ming Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
- Center of Vascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
- *Correspondence: Chang Shu
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6
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Matsuda T, Ishikawa T, Oono T, Sasaki R, Hidaka I, Okada M, Sakaida I. Rendezvous therapy with endoscopic and endovascular treatments for rectal arteriovenous malformation: A case report. Endoscopy 2022; 54:E77-E78. [PMID: 33723845 DOI: 10.1055/a-1388-6021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Takashi Matsuda
- Department of Liver Regenerative Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tsuyoshi Ishikawa
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takashi Oono
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Ryo Sasaki
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Isao Hidaka
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Munemasa Okada
- Department of Radiology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Isao Sakaida
- Department of Liver Regenerative Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Morita R, Abo D, Kinota N, Soyama T, Takahashi B, Yoshino Y, Tsuneta S, Kudo K. Successful transvenous embbolization for type II uterine arteriovenous malformation: A case report. Radiol Case Rep 2021; 16:2007-2011. [PMID: 34158882 PMCID: PMC8203566 DOI: 10.1016/j.radcr.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 12/01/2022] Open
Abstract
A 40-year-old female (gravida 3 para 1) presented with menstrual, urinary, and anal pain. Computed tomography revealed type II acquired uterine arteriovenous malformation, a common dilated venous sac with bilateral uterine arteries, and multiple branches of iliac arteries draining to the bilateral ovarian veins. Venous sac transvenous embolization via the left ovarian vein of dominant outflow was planned, since complete arteriovenous malformation occlusion was difficult with super-selective transarterial embolization of multiple feeders. Therefore, transarterial embolization of the minor feeder was performed before completing transvenous embolization using coils and 50% glue under left iliac artery flow control. Immediately thereafter, angiography confirmed the complete disappearance of the uterine arteriovenous malformation, and all pain symptoms remitted. In conclusion, transvenous embolization combined with adjunctive transarterial embolization can be an effective and radical treatment for type II uterine arteriovenous malformations.
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Affiliation(s)
- Ryo Morita
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan.,Department of Diagnostic Imaging, Faculty of Medicine, Hokkaido University, Kita 8, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-0838, Japan
| | - Daisuke Abo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Naoya Kinota
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Takeshi Soyama
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Bunya Takahashi
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Yuki Yoshino
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Faculty of Medicine, Hokkaido University, Kita 8, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-0838, Japan.,Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Kita 8, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan
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Endovascular embolization of a pelvic arteriovenous malformation as preoperative planning of rectal cancer surgery. Surgery 2021. [DOI: 10.1016/j.surg.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jubashi A, Yamaguchi D, Nagatsuma G, Inoue S, Tanaka Y, Yoshioka W, Hino N, Morisaki T, Ario K, Fukui K, Ishimaru H, Tsunada S. Successful retrograde transvenous embolization under balloon occlusion for rectal arteriovenous malformation. Clin J Gastroenterol 2021; 14:594-598. [PMID: 33420667 PMCID: PMC8016791 DOI: 10.1007/s12328-020-01335-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/25/2020] [Indexed: 11/29/2022]
Abstract
A 57-year-old man was admitted to our hospital because of frequent hematochezia. Colonoscopy exhibited a submucosal tumor-like lesion in the lower rectum. Abdominal contrast-enhanced computed tomography showed a rectal arteriovenous malformation (AVM) on the right side wall of the lower rectum. The feeder was the superior rectal artery, with early venous return. Embolization of the draining vein and feeding artery of the AVM with N-butyl-2-cyanoacrylate under balloon occlusion was planned. Angiography of the superior rectal artery showed the nidus in the rectum with early venous return of contrast material. The portal vein was punctured percutaneously under ultrasound guidance, and a balloon catheter advanced to the distal part of the superior rectal vein. Venography under balloon occlusion showed the outflow vein and nidus. Transvenous and transarterial nidus embolization with N-butyl-2-cyanoacrylate under balloon occlusion was then performed. Since the embolization, there have been no further episodes of bleeding. There is no established treatment for AVMs. Successful treatment requires targeting and eradication of the nidus. We successfully performed embolization therapy for a rectal AVM via a retrograde transvenous approach. This technique may be suitable for completely eradicating the nidus without the risk of embolism.
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Affiliation(s)
- Amane Jubashi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Daisuke Yamaguchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan.
- Division of Gastroenterology, Department of Internal Medicine, Saga University, Saga, 849-8501, Japan.
| | - Goshi Nagatsuma
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Suma Inoue
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Yuichiro Tanaka
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Wataru Yoshioka
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Naoyuki Hino
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Tomohito Morisaki
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Keisuke Ario
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Kenichiro Fukui
- Department of Radiology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | | | - Seiji Tsunada
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
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Ishikawa S, Mukai S, Hirata Y, Kohata A, Kai A, Namba Y, Okimoto S, Fujisaki S, Fukuda S, Takahashi M, Fukuda T, Ohdan H. Rectal Arteriovenous Malformation Treated by Transcatheter Arterial Embolization. Case Rep Gastroenterol 2020; 14:7-14. [PMID: 32095120 PMCID: PMC7011768 DOI: 10.1159/000505090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/27/2019] [Indexed: 11/25/2022] Open
Abstract
An 86-year-old man who presented with frequent hematochezia with mild anemia on blood tests was admitted to our hospital. Colonoscopy exhibited a submucosal tumor-like lesion in the lower rectum. CT and MRI showed blood flow into the lesion, but not tumor component. Angiography of the superior rectal artery and left internal iliac artery showed vascular hyperplasia and nidus. Thus, rectal arteriovenous malformation was diagnosed. If bleeding from arteriovenous malformation was out of control, surgical resection was necessary. However, due to the age of the patient, we performed transcatheter arterial embolization and abdominoperineal resection was not needed. Embolization from the left superior rectal artery, middle rectal artery and inferior rectal artery was performed to control the bleeding and to avoid surgery. After embolization, he was followed up for 10 months in our hospital without recurrence.
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Affiliation(s)
- Sho Ishikawa
- Department of Surgery, Chugoku Rosai Hospital, Kure, Japan
| | | | - Yuzo Hirata
- Department of Surgery, Chugoku Rosai Hospital, Kure, Japan
| | - Akihiro Kohata
- Department of Surgery, Chugoku Rosai Hospital, Kure, Japan
| | - Azusa Kai
- Department of Surgery, Chugoku Rosai Hospital, Kure, Japan
| | - Yosuke Namba
- Department of Surgery, Chugoku Rosai Hospital, Kure, Japan
| | - Sho Okimoto
- Department of Surgery, Chugoku Rosai Hospital, Kure, Japan
| | - Seiji Fujisaki
- Department of Surgery, Chugoku Rosai Hospital, Kure, Japan
| | - Saburo Fukuda
- Department of Surgery, Chugoku Rosai Hospital, Kure, Japan
| | | | | | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Abstract
BACKGROUND The place of open surgery in venous malformations (VMs) of knee joint is still discussed. The aim of this study was to evaluate the benefits of surgery in terms of pain, function, and quality of life. DESIGN This was a retrospective observational study. METHODS Thirty-five consecutive young patients undergoing surgery for VMs of the knee between 2011 and 2014 were included. Data collection was performed using a prospective database by reviewing patient records. Pain, mobility of the joint, residual VMs as seen by magnetic resonance imaging, and quality of life were the main outcome endpoints for this study. RESULTS Thirty-five patients (22 females and 13 males, with a median age of 15 y, range of 5 to 20 y) were included. Twenty-seven VMs were localized in and around the knee joint, of which 8 were extensive. Indication for surgery was intermittent or permanent pain.Details of the surgical excisions of the VM are as follows: suprapatellar area in 57%, suprapatellar and infrapatellar area in 29%, infrapatellar area in 2%, limited in the femoropatellar area in 12%. Partial resection of a vastus muscle or patellar retinaculum was necessary for 19 patients.The median duration of the surgery was 4 hours (range: 2 to 7 h). The median hospital stay was 5 days; full-time physiotherapy was systematic for 2 to 3 weeks.After 6 months, 74% had no longer pain, the mobility of the joint was normal for 60%. Of the 33 patients who had a magnetic resonance imaging at 6 months, 86% (28 patients) had no residual intra-articular VMs, and 14% had focal residual VMs.At the last follow-up, 77% (27 patients) had no longer pain, 23% experienced intermittent pain with unusual activities, and 91% (32 patients) had normal mobility of the joint. Quality of life was increased significantly due to the pronounced impact on pain. CONCLUSION Extensive surgical excision of knee VMs is a safe procedure with good outcomes in terms of pain, function, and quality of life. LEVEL OF EVIDENCE Level II-retrospective observational monocentric study.
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12
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Role of color Doppler ultrasonography and multidetector computed tomography angiography in diagnosis of uterine arteriovenous malformations. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Vascular malformations are classified primarily according to their flow characteristics, slow flow (lymphatic and venous) or fast flow (arteriovenous). They can occur anywhere in the body but have a unique presentation when affecting the female pelvis. With a detailed clinical history and the proper imaging studies, the correct diagnosis can be made and the best treatment can be initiated. Lymphatic and venous malformations are often treated with sclerotherapy while arteriovenous malformations usually require embolization. At times, surgical intervention of vascular malformations or medical management of lymphatic malformations has been implemented in a multidisciplinary approach to patient care. This review presents an overview of vascular malformations of the female pelvis, their clinical course, diagnostic studies, and treatment options.
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Affiliation(s)
- Aparna Annam
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
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14
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Abstract
Vascular malformations (VMs) comprise a wide spectrum of lesions that are classified by content and flow characteristics. These lesions, occurring in both focal and diffuse forms, can involve any organ and tissue plane and can cause significant morbidity in both children and adults. Since treatment strategy depends on the type of malformation, correct diagnosis and classification of a vascular lesion are crucial. Slow-flow VMs (venous and lymphatic malformations) are often treated by sclerotherapy, whereas fast-flow lesions (arteriovenous malformations) are generally managed with embolization. In addition, some cases of VMs are best treated surgically. This review will present an overview of VMs in the female pelvis as well as a discussion of endovascular therapeutic techniques.
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Affiliation(s)
- Brian M Christenson
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Denver Anschutz Medical Campus, Aurora, Colorado
| | - Matthew G Gipson
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Denver Anschutz Medical Campus, Aurora, Colorado
| | - Mitchell T Smith
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Denver Anschutz Medical Campus, Aurora, Colorado
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Kędzierski B, Nowak G, Kuśmierska M, Jaźwiec P, Szuba A. Giant congenital malformation of the perirectal plexus in computed tomography imaging - case report. Pol J Radiol 2013; 78:50-3. [PMID: 23807885 PMCID: PMC3693837 DOI: 10.12659/pjr.883945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 02/18/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Congenital arteriovenous malformation (AVM) in the pelvic area is uncommon in males. CASE REPORT The described case is of a giant lesion of this type that caused recurrent hemorrhaging in the lower part of the gastrointestinal tract. Preliminary diagnosis of vascular pathology was made on the basis of an endoscopic examination that revealed numerous pulsating protuberances of the rectal wall, in which blood flow was identified by means of transrectal ultrasonography. Complementing the diagnostics with a CT revealed a considerable extent of malformation, as well as its morphology and anatomical relations with the surrounding tissues. RESULTS Following a two-year follow-up period, the malformation did not progress or demonstrate any intensification of clinical symptoms, therefore the patient continues to undergo conservative treatment.
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Affiliation(s)
- Bartłomiej Kędzierski
- Department of Clinical Radiology and Imaging Diagnostics, 4 Military Hospital in Wrocław, Wrocław, Poland
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Novel endovascular techniques to control in-outflow with dual approach for large pelvic arteriovenous malformation. J Vasc Surg Venous Lymphat Disord 2013; 1:212-5. [DOI: 10.1016/j.jvsv.2012.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 08/13/2012] [Accepted: 09/01/2012] [Indexed: 11/18/2022]
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Rosen RJ, Nassiri N, Drury JE. Interventional Management of High-Flow Vascular Malformations. Tech Vasc Interv Radiol 2013; 16:22-38. [DOI: 10.1053/j.tvir.2013.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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