Korean J Radiol.  2008 Apr;9(2):148-154. 10.3348/kjr.2008.9.2.148.

Ethanol Embolotherapy of Pelvic Arteriovenous Malformations: an Initial Experience

• Bae S
• Do YS
• Shin SW
• Park KB
• Kim DI
• Kim YW
• Cho SK
• Choo SW
• Choo IW

• KMID: 1098194
• DOI: http://doi.org/10.3348/kjr.2008.9.2.148

Abstract

OBJECTIVE
We retrospectively assessed the results of performing ethanol embolization for pelvis arteriovenous malformations (AVMs). MATERIALS AND METHODS: During the past 10 years, eight patients (8 females, age range: 27-52 years) with AVMs in the pelvic wall (n = 3) and uterus (n = 5) underwent staged ethanol embolizations (range: 1-5, mean: 2.5) under general anesthesia. Ethanol embolization was performed by the use of the transcatheter and/or direct puncture techniques. Clinical follow-up was performed for all of the patients, and imaging follow-up was available for seven patients. The therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms, as well as the degree of devascularization observed on post-procedural angiography. RESULTS: During the 20 sessions of ethanol embolization, the solitary transarterial approach was used 14 times, the transvenous approach was used three times and direct puncture was used once. For two patients, the transarterial and transvenous or direct puncture approaches were used together in one session. For four patients, ethanol and coils were used as embolic agents, and n-butyl cyanoacrylate (NBCA) and ethanol were used in one patient. Seven (88%) of eight patients were cured of their AVMs and one patient (12%) displayed improvement. Major complications were seen in two patients (25%). CONCLUSION: Ethanol embolization is effective for the treatment of pelvic arteriovenous malformations, though there is a chance of a major complication.

Keyword

Arteriovenous malformation; Embolism, therpeutic; Interventional procedures

MeSH Terms

Adult
Arteriovenous Malformations/*therapy
Embolization, Therapeutic/adverse effects/*methods
Enbucrilate/administration & dosage
Ethanol/administration & dosage
Female
Humans
Middle Aged
Pelvis/*blood supply
Retrospective Studies
Solvents/administration & dosage
Tissue Adhesives/administration & dosage
Uterus/*blood supply

Figure

• 

  Fig. 1 34-year-old woman (patient 1) with right pelvic wall arteriovenous malformations. A-C. Posteroanterior pelvic angiogram shows arteriovenous malformations with multiple feeding arteries from right internal and external iliac arteries, nidus (arrows) and large draining vein (arrowhead) to right ovarian vein. D, E. After three sessions of ethanol treatment and coil embolizations, arterial and venous phases of posteroanterior angiogram show complete obliteration of arteriovenous malformations.

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  Fig. 2 38-year-old woman (patient 8) with uterine arteriovenous malformations that caused massive vaginal bleeding. A-C. Pretreatment posteroanterior pelvic angiogram shows large arteriovenous malformations in uterus with dilated draining veins. D. Two sessions of transarterial approach with using ethanol were not effective for managing vaginal bleeding. One session of direct puncture of uterine arteriovenous malformations and NBCA (n-butyl cyanoacrylate) embolization was performed to stop the vaginal bleeding. E. Final posteroanterior pelvic angiogram shows complete obliteration of arteriovenous malformations.

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