Endovascular treatment combined with emboloscleorotherapy for pelvic arteriovenous malformations

Purpose To describe the clinical features and treatment outcomes after combined endovascular and embolosclerotherapy treatment of pelvic arteriovenous malformations (AVMs). Methods From November 1996 to May 2011, we treated 12 patients (seven males, five females; mean age, 38.1 ±14.6 years; age range, 23-70 years) with pelvic AVMs. Our treatment strategy was coil embolization of a dilated draining vein of the AVM to reduce blood flow velocity in the AVM lesion and sclerotherapy of the residual arteriovenous fistulae with high-concentration ethanol to eradicate potential AVM recurrence. To ensure effective endovascular treatment, we used transarterial, transvenous, percutaneous, or combined access routes. Treatment outcomes were assessed with periodic computed tomography angiograms and clinical examinations. Results During the follow-up period (mean, 33.2 months; median, 21.3 months; range, 1-96 months) after embolosclerotherapy, we observed complete remission (no residual or recurrent AVM lesion on follow-up computed tomography and complete symptomatic relief) in 10 (83.3%) patients and partial remission in two (16.7%) patients. One major complication of focal bladder necrosis occurred (1/22 sessions, 4.5%, 1/12 patients, 8.3%), but this resolved with conservative treatment. As early procedure-related complications, transient pulmonary hypertension and/or hemoglobinuria developed in 54.5% (12/22 sessions) and 22.7% (5/22 sessions) of patients, respectively. Conclusions Combined embolosclerotherapy of pelvic AVMs with coils and ethanol was efficacious at achieving complete remission.