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Linn YL, Tay KH, Chong TT. Large Pelvic Arteriovenous Malformation - A Bloody Near Miss. Vasc Specialist Int 2021; 37:31. [PMID: 34580239 PMCID: PMC8479140 DOI: 10.5758/vsi.210050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yun Le Linn
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Kiang Hiong Tay
- Division of Radiological Sciences, Singapore General Hospital, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
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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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Complicated Congenital Gluteal Arteriovenous Malformation With Hemorrhage in Pregnancy. Ann Vasc Surg 2013; 27:803.e7-803.e13. [DOI: 10.1016/j.avsg.2012.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/03/2012] [Accepted: 09/06/2012] [Indexed: 11/22/2022]
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Sekiya T, Nishizawa H, Ozawa N, Tada S, Hasegawa K, Hirota Y, Katoh RI, Ban-No T, Udagawa Y. Clinical features and characteristics of blood flow of uterine vascular abnormalities. J Med Ultrason (2001) 2009; 36:19-26. [PMID: 27276905 DOI: 10.1007/s10396-008-0206-y] [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: 10/14/2008] [Accepted: 12/23/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to assess the clinical features and characteristics of the blood flow in uterine vascular abnormalities using ultrasound and magnetic resonance imaging (MRI). METHODS A total of 17 women were diagnosed with uterine vascular abnormalities by ultrasound. The clinical characteristics of the patients and the distribution and waveform of the intrauterine vessels were examined using transvaginal gray-scale and Doppler ultrasonography, spin-echo MRI, and MR angiography. RESULTS The average age of the 17 subjects was 44.3 years, and 5 were postmenopausal women. The number of pregnancies and deliveries was 2.0 and 1.7, respectively. Of the 17 subjects, 7 had a moderate or severe grade of dysmenorrhea and 7 had a history of vascular disease. In all subjects, vaginal ultrasound demonstrated tubular or numerous tortuous anechoic areas in the uterine wall, and Doppler ultrasound showed that the tubular or numerous dilated tortuous vessels had an atypical wave flow, unlike that of an artery or a vein. The distribution of displayed flow varied, and the waveforms of the Doppler ultrasound displayed three patterns. The averages of the pulse Doppler flow indices showed low impedance in the abnormal uterine vessel and the uterine artery, especially in cases of true arteriovenous malformations. MR angiography demonstrated distinct, tortuous, and coiled vascular channels in the pelvis during and just after the arterial phase. CONCLUSION Characterization of the clinical features of uterine vascular abnormalities is considered to be valuable for obstetricians and gynecologists.
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Affiliation(s)
- Takao Sekiya
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan.
| | - Haruki Nishizawa
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Naomi Ozawa
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Shin Tada
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Kiyoshi Hasegawa
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Yutaka Hirota
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Ryo-Ichi Katoh
- Faculty of Radiological Technology, Fujita Health University, School of Health Sciences, Toyoake, Japan
| | - Tatsuo Ban-No
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yasuhiro Udagawa
- Department of Obstetrics and Gynecology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
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Schaeffer EM, Bivalacqua TJ, Hortopan S, Weiss C, Mitchell S, Allaf ME. Cystoscopic management of an extruded coil from arteriovenous fistula embolization using arthroscopic instruments. J Endourol 2008; 22:1527-9. [PMID: 18613787 DOI: 10.1089/end.2008.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pelvic arteriovenous malformation (AVM) is a rare condition in which a section of blood vessels lacks a capillary network, resulting in blood from an artery being delivered directly to a vein. This condition may be congenital or acquired. Percutaneous selective embolization can obliterate AVMs and has increasingly been used for management. Management involves transcatheter embolization with either inert glues, balloons, or fibered titanium coils that are designed to limit the flow through feeding vessels. We describe one potential complication of transcatheter embolization that involves necrosis of the bladder wall with a novel technique for endoscopic management of an extruded coil in the bladder.
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Affiliation(s)
- Edward M Schaeffer
- Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Richards AJ, Hatrick A, Eden CG. Large pelvic arteriovenous malformation complicating laparoscopic radical prostatectomy. Urology 2008; 72:1359-61. [PMID: 18400274 DOI: 10.1016/j.urology.2008.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 12/15/2007] [Accepted: 01/02/2008] [Indexed: 11/15/2022]
Abstract
Pelvic arteriovenous malformations (AVM) are rare, usually congenital, lesions, which can pose significant difficulties for pelvic surgeons. We present a case of an AVM complicating laparoscopic radical prostatectomy. Unexpected failure of preoperative control led to significant intraoperative difficulty. The advantages of an antegrade approach and optimal magnification afforded by the laparoscopic approach led to successful completion of the operation with minimal morbidity.
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Affiliation(s)
- Andrew J Richards
- The Hampshire Clinic, Old Basing and Frimley Park Hospital, Frimley, United Kingdom.
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