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Osuga K, Yokota N, Yamamoto K, Matsutani H, Yamamoto K, Juri H, Ozawa H, Katsumata T. Double Microballoon-occluded Ethanol Embolization for Pelvic Arteriovenous Malformation: A Case Report. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2024; 9:26-30. [PMID: 38525003 PMCID: PMC10955464 DOI: 10.22575/interventionalradiology.2023-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/18/2023] [Indexed: 03/26/2024]
Abstract
A 40-year-old man was incidentally found to have right-sided pelvic arteriovenous malformation (AVM) with an aneurysmal dominant outflow vein (DOV). The AVM had two main feeding arteries forming a cluster of fine vessels shunt to the DOV. As transvenous approach was impossible due to anatomical difficulty, transarterial ethanol embolization was performed under simultaneous double microballoon occlusion of the two feeding arteries in combination with protective coil embolization of the prostatic branches. Ethanol (13 mL) was intermittently injected from both microballoon catheters until the AV shunt was completely occluded. At 1-year follow-up, contrast-enhanced CT revealed shrinkage of the thrombosed DOV without any symptom. Our case demonstrated the usefulness of simultaneous double microballoon-occluded ethanol embolization for treating a localized pelvic AVM with a few feeding arteries.
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Affiliation(s)
- Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Naoki Yokota
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuhiro Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Hiroki Matsutani
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Kiyohito Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Hiroshi Juri
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Hideki Ozawa
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University, Japan
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University, Japan
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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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Nguyen LD, Tran HM, Le HA, Nguyen TT, Bui KT, Hoang LM, Nguyen TS, Nguyen HH. Pelvic arteriovenous malformation mimicking benign prostatic hyperplasia: A case report. Urol Case Rep 2023; 50:102519. [PMID: 37593360 PMCID: PMC10427981 DOI: 10.1016/j.eucr.2023.102519] [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: 07/08/2023] [Revised: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023] Open
Abstract
Pelvic arteriovenous malformation is a rare vascular abnormality, espescially in male patients, and is difficult to treat because of its nature supplied by multiple arterial feeders. We report a 70-year-old male patient admitted due to symptoms of benign prostatic hyperplasia. Ultrasound was performed initially, and no other abnormalities were found other than an enlarged prostate. CT scan later demonstrated a pelvic arteriovenous malformation adjacent to the prostate, with multiple arterial feeders from the right internal iliac artery. Angiography confirmed the diagnosis, and transaterial embolization was successfully done. The symptoms disappeared several days later, and the patient remained asymptompmatic during follow-up.
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Affiliation(s)
- Luan D. Nguyen
- Head of Interventional Radiology Unit, Radiology Department, Nhan Dan Gia Dinh Hospital, Viet Nam
| | - Hien M. Tran
- Interventional Radiology Unit, Radiology Department, Nhan Dan Gia Dinh Hospital, Viet Nam
| | - Huy A. Le
- Interventional Radiology Unit, Radiology Department, Nhan Dan Gia Dinh Hospital, Viet Nam
| | - Tai T. Nguyen
- Interventional Radiology Unit, Radiology Department, Nhan Dan Gia Dinh Hospital, Viet Nam
| | - Kinh T. Bui
- Interventional Radiology Unit, Radiology Department, Nhan Dan Gia Dinh Hospital, Viet Nam
| | - Loi M. Hoang
- Hue University of Medicine and Pharmacy, Viet Nam
| | | | - Hai H. Nguyen
- Nhan Dan Gia Dinh Hospital, General Director, Viet Nam
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Nazari I, Zargar MA, Panahi P, Alavi SMA. Pelvic arteriovenous malformation (AVM) with recurrent hematuria: A case report. Int J Surg Case Rep 2023; 110:108701. [PMID: 37633193 PMCID: PMC10509810 DOI: 10.1016/j.ijscr.2023.108701] [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: 07/16/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION Arteriovenous malformation (AVM) leads to a direct connection between arterial and venous networks, in which capillary branches are not involved. Pelvic AVM is a benign and rare condition causing severe pain, hematuria, and rectal or vaginal bleeding. CASE PRESENTATION A 36-year-old woman presented with five months history of hematuria. Her medical history was unremarkable, and laboratory findings were all within normal ranges. Abdominopelvic computed tomography (CT) scan revealed a vascular mass in the left lateral pelvis that extended to the bladder neck and was suggestive of an AVM. The patient underwent a laparotomy for the resection of AVM. The first angiography revealed an AVM in the left internal iliac artery. The patient underwent embolization with coil and gel foam. The second angiography revealed complete obstruction of the left internal iliac artery due to multiple coils and AVM of the right internal iliac artery (RIIA), embolized with glue and lipiodol. A week later, venography revealed another left iliac vein malformation embolized with foam sclerotherapy. Forty days later, the third angiography revealed another AVM in the right iliac artery, embolized with three vials of polyvinyl alcohol (PVA). Following two months of follow-up, the symptoms did not return. DISCUSSION The present study reported a rare case of recurrent pelvic AVM causing painless hematuria in a female patient. The lesion was treated with several angioembolization sessions. CONCLUSION Angioembolization is one of the main therapeutic options for AVM. Appropriate material should be precisely chosen for AVM embolization regarding the AVM's location, size, and condition.
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Affiliation(s)
- Iraj Nazari
- Department of General Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Amin Zargar
- Department of General Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Pegah Panahi
- Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Huang Y, Liu X, Qian H. A male congenital pelvic arteriovenous malformation diagnosed by abdominal ultrasound: A case report and literature review. Front Surg 2023; 9:907234. [PMID: 36700008 PMCID: PMC9869679 DOI: 10.3389/fsurg.2022.907234] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Congenital pelvic arteriovenous malformation (AVM) is a rare vascular abnormality whereby arteries and veins are directly connected with malformed vascular plexus. Owing to its low incidence and nonspecific symptoms, the ultrasonographic characteristics of congenital pelvic AVM in males have been infrequently studied. A 30-year-old man visited our hospital complaining of progressive pain in the right lower abdomen and lumbar area since 2 months previously. Abdominal ultrasound (US) was performed at the initial examination and pelvic AVM was diagnosed, which was then confirmed by computed tomographic angiography. After right internal iliac artery embolization, the patient recovered uneventfully and remained asymptomatic during the 12-month follow-up period. Congenital pelvic AVM should thus be included in the differential diagnosis of pelvic cystic masses in males despite its low incidence, with US also being of great diagnostic value. We describe the ultrasonic features of AVM in detail and hope that this study may contribute to the ultrasonic diagnosis of congenital pelvic AVM in males.
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Affiliation(s)
- Yanhua Huang
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing, China
| | - Xiatian Liu
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing, China
| | - Hongwei Qian
- Department of Hepatobiliary and Pancreatic Surgery, Shaoxing People's Hospital, Shaoxing, China.,Shaoxing Key Laboratory of Minimally Invasive Abdominal Surgery and Precise Treatment of Tumor, Shaoxing, China
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Takahashi H, Potretzke TA, Kawashima A, Cheville JC, Masuoka S, Kim B. Imaging of the Bulbourethral (Cowper) Gland: Abnormalities and Differential Diagnosis. Radiographics 2022; 42:2037-2053. [PMID: 36149823 DOI: 10.1148/rg.220099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Normal Cowper glands and ducts are imperceptible at imaging. However, abnormalities of the Cowper glands and ducts are increasingly seen owing to increasing use of cross-sectional imaging. In this article, the authors present a comprehensive review of the normal anatomy of the Cowper glands and ducts and the clinical and imaging findings of conditions that affect them in an effort to help lead to appropriate diagnosis and management. A Cowper duct syringocele is a congenital or acquired dilatation of the Cowper duct in the bulb of the corpus spongiosum. Retrograde urethrography is the standard test to diagnose a communicating (open) Cowper duct syringocele, and MRI is used for further morphologic assessment. Cowperitis refers to inflammation of the gland and/or duct, and recurrent cowperitis is usually associated with an underlying syringocele, a urethral fistulous connection to the Cowper gland, or a perianal fistula. MRI allows detection of the underlying structural abnormality and the superimposed inflammation. Cowper stones are typically radiopaque and are found in both the Cowper gland and duct. A Cowper gland HHhemorrhagic cyst may be incidentally detected at MRI of the prostate, and follow-up MRI may be required to ensure evolution of hemorrhage and exclude an underlying neoplasm. Cowper gland carcinoma is rare and includes adenocarcinoma and adenoid cystic carcinoma subtypes. Transperineal US may be used for initial evaluation and CT and/or MRI are necessary for further characterization and staging. Cowper gland hyperplasia is a rare entity with few previous reports that may be incidentally detected at imaging and may mimic malignancy. ©RSNA, 2022.
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Affiliation(s)
- Hiroaki Takahashi
- From the Department of Diagnostic Radiology (H.T., T.A.P., B.K.) and Department of Laboratory Medicine and Pathology (J.C.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.); and Department of Diagnostic Radiology, University of Tsukuba, Tsukuba, Japan (S.M.)
| | - Theodora A Potretzke
- From the Department of Diagnostic Radiology (H.T., T.A.P., B.K.) and Department of Laboratory Medicine and Pathology (J.C.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.); and Department of Diagnostic Radiology, University of Tsukuba, Tsukuba, Japan (S.M.)
| | - Akira Kawashima
- From the Department of Diagnostic Radiology (H.T., T.A.P., B.K.) and Department of Laboratory Medicine and Pathology (J.C.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.); and Department of Diagnostic Radiology, University of Tsukuba, Tsukuba, Japan (S.M.)
| | - John C Cheville
- From the Department of Diagnostic Radiology (H.T., T.A.P., B.K.) and Department of Laboratory Medicine and Pathology (J.C.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.); and Department of Diagnostic Radiology, University of Tsukuba, Tsukuba, Japan (S.M.)
| | - Sota Masuoka
- From the Department of Diagnostic Radiology (H.T., T.A.P., B.K.) and Department of Laboratory Medicine and Pathology (J.C.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.); and Department of Diagnostic Radiology, University of Tsukuba, Tsukuba, Japan (S.M.)
| | - Bohyun Kim
- From the Department of Diagnostic Radiology (H.T., T.A.P., B.K.) and Department of Laboratory Medicine and Pathology (J.C.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (A.K.); and Department of Diagnostic Radiology, University of Tsukuba, Tsukuba, Japan (S.M.)
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7
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Patel RJ, Cosman BC, Owens EL, Malas MB. Migration of vascular embolisation material from the intravascular space to surrounding interstitial tissues in arteriovenous malformations. BMJ Case Rep 2022; 15:e249406. [PMID: 35606037 PMCID: PMC9125736 DOI: 10.1136/bcr-2022-249406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/03/2022] Open
Abstract
We present the case of a young man active duty in the military who initially presented with pelvic pain and fullness during sexual activity. Extensive workup showed a large pelvic arteriovenous malformation (AVM). He underwent over 10 interventional radiology procedures to embolise his AVM and suffered multiple postoperative complications resulting in exploratory laparotomies, bowel resections and ultimately a colostomy. Six years after his embolisation procedures, he was found on imaging to have gluteal fluid collections with metallic particles, presumed to be migrated Onyx from his angioembolisations as a result of non-target embolisation. Current literature does not document other instances of Onyx material migrating from an intravascular source to interstitial tissue.
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Affiliation(s)
- Rohini J Patel
- Vascular Surgery, University of California San Diego Health System, La Jolla, CA, USA
| | - Bard C Cosman
- General Surgery, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Erik L Owens
- Vascular Surgery, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Mahmoud B Malas
- Vascular Surgery, University of California San Diego Health System, La Jolla, CA, USA
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Kishino M, Nishida K, Kimura K, Takahashi M, Nakaminato S, Kume H, Uchiyama H, Kudo T, Kawada S, Mori K, Tateishi U. Paravesical space arteriovenous malformation as a specific subgroup of pelvic vascular anomaly: a case series and review of literature. Jpn J Radiol 2020; 38:434-439. [PMID: 32043235 DOI: 10.1007/s11604-020-00924-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/25/2020] [Indexed: 11/27/2022]
Abstract
Treatment of pelvic arteriovenous malformations (AVMs) is frequently challenging because of the complex structures and anatomical diversity among cases. We present a case series of six patients with pelvic AVMs. All patients had a similar anatomical structure consisting of multiple feeders from the unilateral internal iliac artery, collecting into a dilated venous sac in the unilateral paravesical space and draining into a single outflow, eventually joining the pre-prostatic vein or internal iliac vein. Five among these patients were successfully treated by catheter-directed embolo-sclerotherapy. In addition to our six cases, we identified six previous case reports of pelvic AVM with similar anatomical characteristics. Herein, we summarize the clinical and anatomical features of these 12 paravesical AVM cases. In all cases, the patients were men; the AVM was predominantly located at the right paravesical space and demonstrated good therapeutic effect of catheter-directed embolosclerotherapy. These paravesical AVMs may constitute a new subgroup of pelvic vascular anomalies with the same etiology that are treatable by adequate catheter intervention.
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Affiliation(s)
- Mitsuhiro Kishino
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Kenji Nishida
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koichiro Kimura
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Marie Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shuichiro Nakaminato
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hiroko Kume
- Department of Vascular Surgery, Moriya Keiyu Hospital, Moriya, Japan
| | - Hidetoshi Uchiyama
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Toshifumi Kudo
- Department of Vascular Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuichi Kawada
- Department of Diagnostic Radiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Kouichi Mori
- Department of Diagnostic Radiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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9
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Abstract
Magnetic resonance imaging (MRI) has been increasingly used in the detection, localization, and staging of prostate cancer. Because of its excellent soft tissue contrast and multiplane imaging, it can be also very useful in the evaluation of benign prostate diseases. Prostatic benign disorders have a high prevalence, vastly represented by benign prostatic hyperplasia and prostatitis. On the contrary, benign prostatic neoplasms are extremely rare, represented by multilocular cystadenoma, leiomyomas, hemangioma, and granular cell tumor, although these uncommon tumors have been most encountered due to widespread use of MRI. Congenital prostatic anomalies are associated with defects in the development of the prostate embryology, including hypoplasia, ectopia, and vascular malformations, abnormalities rarely seen on cross-sectional imaging. Prostatic cysts are the most common development abnormalities and occasionally are related to clinical symptoms, mainly due to infection and hemorrhage. As with prostate cancer, multiparametric MRI is a reliable tool for the diagnosis and management of benign prostatic diseases as well, providing additional information such morphological changes of the prostate, more accurate prostatic measurements, and functional characteristics of nonmalignant prostatic lesions. In this review, we discuss MRI findings of these benign prostatic diseases.
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10
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Palialexis K, Magoufis G, Spiliopoulos S, Reppas L, Filippiadis D, Brountzos E. Pressure Cooker Technique for the Treatment of a Pelvic Arteriovenous Malformation Associated with a Giant Venous Aneurysmal Dilatation. Cardiovasc Intervent Radiol 2020; 43:165-167. [PMID: 31646377 DOI: 10.1007/s00270-019-02352-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/09/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Konstantinos Palialexis
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - George Magoufis
- Division of Interventional Neuroradiology, Metropolitan Hospital, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Filippiadis
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Doiz Artázcoz E, Manosalbas Rubio IM, González Calbo A, Martín Cañuelo JJ, Rodríguez Piñero M. Symptomatic pelvic arteriovenous malformation treated successfully with an endovascular approach. Cir Esp 2019; 98:493-495. [PMID: 31858973 DOI: 10.1016/j.ciresp.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 09/18/2019] [Accepted: 11/10/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Esther Doiz Artázcoz
- UGC de Angiología y Cirugía Vascular, Hospital Universitario Puerta del Mar, Cádiz, España.
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12
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Owari T, Tanaka N, Nakai Y, Asakawa I, Tomizawa M, Miyake M, Morizawa Y, Hori S, Anai S, Hasegawa M, Fujimoto K. Localized prostate cancer with pelvic arteriovenous malformation treated with low-dose-rate brachytherapy after transcatheter embolization: Two case reports. IJU Case Rep 2019; 2:90-94. [PMID: 32743382 PMCID: PMC7292068 DOI: 10.1002/iju5.12048] [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: 08/24/2018] [Accepted: 01/14/2019] [Indexed: 11/22/2022] Open
Abstract
Background We describe two patients who underwent low‐dose‐rate prostate brachytherapy after embolization for pelvic arteriovenous malformation. Case presentation Case 1: A 76‐year‐old man was referred for definitive treatment of intermediate‐risk prostate cancer (prostate‐specific antigen 8.667 ng/mL, cT2aN0M0, Gleason score 3 + 4 = 7). We planned low‐dose‐rate brachytherapy. However, magnetic resonance imaging and computed tomography demonstrated a large pelvic arteriovenous malformation. We performed embolization of the arteriovenous malformation before initiating treatment to lower the risk of rupture of the arteriovenous malformation during low‐dose‐rate brachytherapy. Case 2: A 69‐year‐old man was referred for the definitive treatment of high‐risk prostate cancer (prostate‐specific antigen 5.81 ng/mL, cT2aN0M0, Gleason score 4 + 4 = 8) with a pelvic arteriovenous malformation. Similar to Case 1, we performed embolization of the arteriovenous malformation before initiating treatment. In both cases, low‐dose‐rate brachytherapy could be performed without complications. Conclusions Low‐dose‐rate brachytherapy after transcatheter embolization of pelvic arteriovenous malformations can safely and effectively treat localized prostate cancer with pelvic arteriovenous malformations.
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Affiliation(s)
- Takuya Owari
- Department of Urology; Nara Medical University; Kashihara, Nara Japan
| | - Nobumichi Tanaka
- Department of Urology; Nara Medical University; Kashihara, Nara Japan
| | - Yasushi Nakai
- Department of Urology; Nara Medical University; Kashihara, Nara Japan
| | - Isao Asakawa
- Department of Radiation Oncology; Nara Medical University; Kashihara, Nara Japan
| | - Mitsuru Tomizawa
- Department of Urology; Nara Medical University; Kashihara, Nara Japan
| | - Makito Miyake
- Department of Urology; Nara Medical University; Kashihara, Nara Japan
| | - Yosuke Morizawa
- Department of Urology; Nara Medical University; Kashihara, Nara Japan
| | - Shunta Hori
- Department of Urology; Nara Medical University; Kashihara, Nara Japan
| | - Satoshi Anai
- Department of Urology; Nara Medical University; Kashihara, Nara Japan
| | - Masatoshi Hasegawa
- Department of Radiation Oncology; Nara Medical University; Kashihara, Nara Japan
| | - Kiyohide Fujimoto
- Department of Urology; Nara Medical University; Kashihara, Nara Japan
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Ripepi M, Varetto G, Gibello L, Ruffino MA, Fonio P, Rispoli P. Successful percutaneous transgluteal embolization of a complex arteriovenous malformation feeding a hypogastric artery aneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:45-49. [PMID: 29556591 PMCID: PMC5856678 DOI: 10.1016/j.jvscit.2017.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/14/2017] [Indexed: 11/17/2022]
Abstract
Pelvic arteriovenous malformation (AVM) is a rare condition mostly requiring a complex therapeutic strategy. The surgical approach is challenging and burdened by relatively high mortality and morbidity rates. No guidelines are available for the endovascular treatment of AVM because the literature is limited to small case series and case reports. We present a complex case of a pelvic AVM associated with an internal iliac artery aneurysm in a patient previously treated with a common to external prosthetic substitution for aneurysm and proximal ligation of internal iliac artery.
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Affiliation(s)
- Matteo Ripepi
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, Città della Salute e della Scienza, San Giovanni Battista Hospital, Turin, Italy
| | - Gianfranco Varetto
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, Città della Salute e della Scienza, San Giovanni Battista Hospital, Turin, Italy
| | - Lorenzo Gibello
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, Città della Salute e della Scienza, San Giovanni Battista Hospital, Turin, Italy
- Correspondence: Lorenzo Gibello, MD, Città della Salute e della Scienza, Corso Bramante 88, Turin 10126, Italy
| | - Maria Antonella Ruffino
- Division of Vascular Radiology, Cardiovascular Department, Città della Salute e della Scienza, San Giovanni Battista Hospital, Turin, Italy
| | - Paolo Fonio
- Division of Vascular Radiology, Cardiovascular Department, Città della Salute e della Scienza, San Giovanni Battista Hospital, Turin, Italy
| | - Pietro Rispoli
- Division of Vascular Surgery, Department of Surgical Sciences, University of Turin, Città della Salute e della Scienza, San Giovanni Battista Hospital, Turin, Italy
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14
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Bekci T, Yucel S, Turgut E, Soylu AI. Giant Congenital Pelvic AVM Causing Cardiac Failure, Diplegia, and Neurogenic Bladder. Pol J Radiol 2015; 80:388-90. [PMID: 26634010 PMCID: PMC4540055 DOI: 10.12659/pjr.894700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/05/2015] [Indexed: 12/21/2022] Open
Abstract
Background Pelvic arteriovenous malformations (AVMs) are uncommon lesions and only a rare number of male cases have been reported. Their clinical presentations are variable and imaging modalities have an important place in diagnosis and treatment planning. Case Report We present the imaging findings of a giant congenital pelvic AVM that was diagnosed in a 30-year-old male patient eight years ago and which progressed despite follow-up and treatment, causing cardiac failure, diplegia, and neurogenic bladder. Conclusions Pelvic AVMs are uncommon lesions and they can present with various symptoms based on their locations and sizes. Delays in the diagnosis and treatment can cause local and systemic complications. Imaging is very important in the diagnosis of pelvic AVM.
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Affiliation(s)
- Tumay Bekci
- Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| | - Serap Yucel
- Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| | - Eser Turgut
- Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| | - Aysegul Idil Soylu
- Department of Radiology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
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15
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Addo EA, Emtage J, Massis K, Hernandez DJ. A Congenital High Flow Arteriovenous Malformation of the Bladder Presenting With Polypoid Cystitis and Ureteral Obstruction. Urol Case Rep 2015; 3:181-4. [PMID: 26793545 PMCID: PMC4714302 DOI: 10.1016/j.eucr.2015.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/19/2015] [Indexed: 11/29/2022] Open
Abstract
A 21-year-old male with a history of Down's syndrome presented with hematuria and right flank pain. Computed Tomography (CT) of the abdomen/pelvis revealed right hydronephrosis and a right-sided pelvic vascular abnormality. Angiography revealed an arteriovenous malformation (AVM) fed by the right superior and inferior vesical arteries and nephrostogram showed a long segment of obstructed distal right ureter. Cystoscopy revealed erythema and edema of the right hemi-bladder and biopsy diagnosed polypoid cystitis. Treatment was performed by transarterial embolization with ethylene vinyl alcohol copolymer. Follow up cystoscopy and retrograde pyelography at 3 months post-procedure showed resolution of all visible pathology.
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Affiliation(s)
- Eric A. Addo
- University of South Florida, 2 Tampa General Circle, STC 7028, Tampa, FL 33606, USA
- Corresponding author.
| | - Justin Emtage
- University of South Florida, 2 Tampa General Circle, STC 6, Tampa, FL 33606, USA
| | - Kamal Massis
- University of South Florida, 2 Tampa General Circle, STC 7028, Tampa, FL 33606, USA
| | - David J. Hernandez
- University of South Florida, 2 Tampa General Circle, STC 6, Tampa, FL 33606, USA
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16
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Conway AM, Qato K, Drury J, Rosen RJ. Embolization techniques for high-flow arteriovenous malformations with a dominant outflow vein. J Vasc Surg Venous Lymphat Disord 2015; 3:178-83. [DOI: 10.1016/j.jvsv.2014.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/22/2014] [Indexed: 11/25/2022]
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17
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Concomitant transarterial and transvenous embolization of a pelvic arteriovenous malformation using a new liquid embolic agent, squid-12 and detachable coils. Case Rep Vasc Med 2014; 2014:972870. [PMID: 25180118 PMCID: PMC4142281 DOI: 10.1155/2014/972870] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/16/2014] [Indexed: 11/17/2022] Open
Abstract
We describe a complex congenital pelvic AVM with multiple feeding arteries arising from the side branches of the right internal iliac artery and a single draining vein in a male patient. Concomitant transarterial and transvenous embolization with a new liquid embolic agent Squid-12 and metallic coils enabled a complete embolization at a single session. Squid-12 is composed of ethylene vinyl alcohol copolymers and its lower viscosity makes it a promising agent for the treatment of AVMs. The patient showed prompt resolution of the symptoms and complete devascularization of the AVM lesion was persisted on the 1-month control angiography. The patient was asymptomatic on the 6th month follow-up.
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18
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Malformación arteriovenosa pudenda con trombosis espontánea secundaria de cuerpo cavernoso. Reporte de caso. UROLOGÍA COLOMBIANA 2014. [DOI: 10.1016/s0120-789x(14)50047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Malformação arteriovenosa da artéria hipogástrica — A propósito de um caso clínico. ANGIOLOGIA E CIRURGIA VASCULAR 2014. [DOI: 10.1016/s1646-706x(14)70028-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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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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21
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Soeda S, Ushijima J, Furukawa S, Miyajima M, Sakuma K, Watanabe T, Miyazaki M, Hashimoto Y, Nishiyama H, Fujimori K. Uterine arteriovenous malformation formed in a large uterine cervical myoma. TOHOKU J EXP MED 2013; 228:181-7. [PMID: 23060199 DOI: 10.1620/tjem.228.181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Arteriovenous malformation (AVM) can arise in various organs, particularly the brain, but it is rare in the uterus. Uterine AVM is potentially lethal and is generally associated with uterine trauma, such as dilatation and curettage, therapeutic abortion or uterine surgery. On the other hand, uterine myoma is the most common benign gynecological tumor, but uterine cervical myoma is rare and grows in the extraperitoneal space, with development of complex capillary networks within the tumor. Cervical myoma surgery is therefore a difficult operation with a risk of massive bleeding. We report herein a patient with uterine AVM formed within a large cervical myoma in a postmenopausal woman. The patient was a 55-year-old Japanese woman who complained of lower abdominal distension. Ultrasonography, computed tomography and magnetic resonance imaging showed an 18 × 20-cm uterine cervical tumor with dilatation of numerous vessels. Pelvic angiography was scheduled to provide accurate diagnosis and to minimize intraoperative blood loss. In fact, preoperative pelvic angiography allowed us to identify the true feeding artery and drainage veins. Occlusion of the feeding artery with a balloon device is effective in decreasing intraoperative bleeding. Abdominal total hysterectomy was performed as the surgical management of this uterine AVM. Prophylactic endovascular balloon occlusion of the ipsilateral internal iliac artery reduced the amount of hemorrhage during surgery, although blood transfusion was needed in our patient. In conclusion, preoperative embolosclerotherapy should be considered as a treatment option in patients with AVM present in a large uterine cervical myoma.
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Affiliation(s)
- Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan.
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22
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Shanbhogue AK, Fasih N, Macdonald DB, Sheikh AM, Menias CO, Prasad SR. Uncommon primary pelvic retroperitoneal masses in adults: a pattern-based imaging approach. Radiographics 2012; 32:795-817. [PMID: 22582360 DOI: 10.1148/rg.323115020] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is a broad spectrum of primary pelvic retroperitoneal masses in adults that demonstrate characteristic epidemiologic and histopathologic features and natural histories. These masses may be classified into five distinct subgroups using a pattern-based approach that takes anatomic distribution and certain imaging characteristics into account, allowing greater accuracy in their detection and characterization and helping to optimize patient management. The five groups are cystic (serous and mucinous epithelial neoplasms, pelvic lymphangioma, tailgut cyst, ancient schwannoma), vascular or hypervascular (solitary fibrous tumor, paraganglioma, pelvic arteriovenous malformation, Klippel-Trénaunay-Weber syndrome, extraintestinal GIST [gastrointestinal stromal tumor]), fat-containing (lipoma, liposarcoma, myelolipoma, presacral teratoma), calcified (calcified lymphocele, calcified rejected transplant kidney, rare sarcomas), and myxoid (schwannoma, plexiform neurofibroma, myxoma).Cross-sectional imaging modalities help differentiate the more common gynecologic neoplasms from more unusual masses. In particular, the tissue-specific multiplanar capability of high-resolution magnetic resonance imaging permits better tumor localization and internal characterization, thereby serving as a road map for surgery.
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Affiliation(s)
- Alampady K Shanbhogue
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
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23
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Koganemaru M, Abe T, Iwamoto R, Suenaga M, Matsuoka K, Hayabuchi N. Pelvic arteriovenous malformation treated by superselective transcatheter venous and arterial embolization. Jpn J Radiol 2012; 30:526-9. [PMID: 22492471 DOI: 10.1007/s11604-012-0081-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 03/25/2012] [Indexed: 11/24/2022]
Abstract
We describe a rare case of hematuria and hemospermia associated with pelvic arteriovenous malformation (AVM) in a male patient treated by transcatheter embolization. Understanding AVM hemodynamics contributes to the elucidation of its pathology and improves the outcome of embolization. In the present case, multiple arteriolar components shunted to the initial part of a single dominant outflow vein. Superselective embolization of a draining vein and feeding artery with an n-butyl cyanoacrylate/lipiodol mixture and polyvinyl alcohol particles was effective in terms of shunt disappearance and minimizing the need for subsequent arterial embolization.
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Affiliation(s)
- Masamichi Koganemaru
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
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24
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Mangold S, Ketelsen D, Syha R, Balletshofer B, Kalender G, Kramer U, Claussen CD, Brechtel K. Endovascular treatment of a real inferior gluteal artery aneurysm associated with a pelvic arteriovenous malformation. Cardiovasc Intervent Radiol 2011; 34:1102-5. [PMID: 21431977 DOI: 10.1007/s00270-011-0131-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Mallios A, Laurian C, Houbballah R, Gigou F, Marteau V. Curative treatment of pelvic arteriovenous malformation--an alternative strategy: transvenous intra-operative embolisation. Eur J Vasc Endovasc Surg 2011; 41:548-53. [PMID: 21277234 DOI: 10.1016/j.ejvs.2010.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Pelvic arteriovenous malformations (AVMs) are difficult to treat. Arterial embolisation is the most common strategy but often has poor results. We report an alternative surgical approach of controlled intra-operative transvenous embolisation with long-term results in seven cases. MATERIALS AND METHODS Between 1980 and 2008, we treated seven patients (four men, three women, mean age 50 years). Indications were rectal bleeding (one case), urinary tract problems (four cases), oedema of lower limb (one case) and high-output cardiac failure (one case). Four of them had previous operations and three had previous attempts for embolisation. Embolisation of the malformation was performed through the internal iliac vein. This was done after clamping of all the feeding and draining vessels. The agent used was cyanocrylate (one case), Ethibloc (one case) and bone wax (five cases). RESULTS Mortality was 0%. Complications occurred in two patients (28,5%), one pulmonary embolism and one regressive femoral paresis. Three patients were re-operated for various reasons. The mean follow-up period was 6 years (1-12 years). Symptoms resolved in all patients, while control by computed tomography (CT) angioscan revealed one residual shunt. CONCLUSION Complete surgical excision of pelvic AVMs is not always possible. Embolisation does not offer a permanent cure. Intra-operative transvenous embolisation of persisting complex AVMs appears to be an alternative approach with good immediate and long-term results. Ethylene glycol appears to be the most suitable agent.
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Affiliation(s)
- A Mallios
- Department of Vascular Surgery, Saint-Joseph Hospital, Paris, France.
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26
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A New Therapeutic Approach to Congenital Pelvic Arteriovenous Malformations. Ann Vasc Surg 2010; 24:1102-9. [DOI: 10.1016/j.avsg.2010.02.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 02/16/2010] [Accepted: 02/18/2010] [Indexed: 11/15/2022]
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27
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Shankarappa RK, Panneerselvam A, Dwarakaprasad R, Chikkaswamy SB, Nayak MH, Nanjappa MC. Novel transcatheter closure of internal iliac arteriovenous malformation. Cardiovasc Interv Ther 2010; 26:138-41. [DOI: 10.1007/s12928-010-0041-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 09/01/2010] [Indexed: 11/28/2022]
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28
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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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29
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Gandini R, Angelopoulos G, Konda D, Messina M, Chiocchi M, Perretta T, Simonetti G. Transcatheter Embolization of a Large Symptomatic Pelvic Arteriovenous Malformation with Glubran 2 Acrylic Glue. Cardiovasc Intervent Radiol 2007; 31:1030-3. [PMID: 17968618 DOI: 10.1007/s00270-007-9224-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 09/21/2007] [Accepted: 10/08/2007] [Indexed: 11/24/2022]
Affiliation(s)
- R Gandini
- Interventional Radiology Department, University Hospital of Rome Tor Vergata, Rome, Italy
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30
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Bozlar U, Norton PT, Turba UC, Hagspiel KD. Novel technique for evaluating complex pelvic arteriovenous malformations with catheter-directed subtracted MR angiography. J Vasc Interv Radiol 2007; 18:920-3. [PMID: 17609455 DOI: 10.1016/j.jvir.2007.04.003] [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] [Indexed: 11/17/2022] Open
Abstract
Residual or recurrent arteriovenous malformation (AVM) nidal filling is not uncommon after embolization of complex peripheral AVMs. The major reason for this is incomplete embolization of the nidus owing to failure to detect all feeder vessels other than the dominant one. Herein, the authors describe a novel "intravenous minus intraarterial" subtraction magnetic resonance (MR) angiography technique that enabled the delineation of additional feeding branches not clearly identifiable at intravenous contrast-enhanced MR angiography or nonselective pelvic angiography. This technique may be particularly useful in the evaluation of complex AVMs and their subsequent management with embolization.
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Affiliation(s)
- Ugur Bozlar
- Department of Radiology, University of Virginia Health System, Charlottesville, VA 22908, USA
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31
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Ashley RA, Patterson DE, Bower TC, Stanson AW. Large congenital pelvic arteriovenous malformation and management options. Urology 2006; 68:203.e11-3. [PMID: 16850535 DOI: 10.1016/j.urology.2006.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The congenital pelvic arteriovenous malformation (AVM) arises from dysplastic arteries and veins. These rare conditions might present to the urologist by producing massive hematuria. Most AVMs can be controlled by surgical resection, usually in conjunction with preoperative angiographic embolization. Here, we present a case of a large pelvic AVM that caused significant patient morbidity and required treatment by novel methods after the usual means had failed. In this report, we will detail those unique interventions required to control a tenuous clinical situation.
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Affiliation(s)
- Richard A Ashley
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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32
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Virmani R, Burke AP, Taylor AJ. Congenital Malformations of the Vasculature. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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33
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Park JM, Park YK, Chang SG. Arteriovenous malformation of the urinary bladder: Treated by transurethral resection. Int J Urol 2005; 12:409-11. [PMID: 15948732 DOI: 10.1111/j.1442-2042.2005.01054.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A localized arteriovenous malformation of the bladder is extremely rare. To our knowledge, arteriovenous malformation of the bladder has been reported in limited number of cases in the published literature. When arteriovenous malformation is suspected, an angiogram and pelvic computed tomography or magnetic resonance imaging is essential to delineate the extent of the disease and to plan appropriate therapy. Common symptoms include pain, gross hematuria and acute urinary retention. No well-established guidelines exist concerning their management. We report a case of an arteriovenous malformation of the urinary bladder that was successfully treated by transurethral resection.
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Affiliation(s)
- Jong-Min Park
- Department of Urology School of Medicine, Kyung Hee University, Seoul, Korea
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