13th Annual Global Embolization Symposium & Technologies
Purpose : To determine the curative role of ethanol endovascular and/or ethanol coils in the treatment of large pelvic arteriovenous malformations (AVMs).
Material and Methods : 48 patients (25 females; 23 males; age range: 4 - 86 years; mean age: 37 years) underwent 315 endovascular procedures (6.5 procedure/patient) to treat their pelvic AVMs. Two patients had bilateral pelvic AVMs (1 male; 1 female). Two patients had traumatic lesions (2 males). Patients underwent transarterial, retro-grade transvenous, and direct puncture embolization procedures. Embolic agents included absolute ethanol and coils, at times in combination.
Results : 41 patients are cured of their pelvic AVM (mean follow-up: 43 months) and 7 patients’ treatments are on-going. Pelvic AVMs were cured by using ethanol, coils, or in combination. The addition of coils was particularly useful in those AVMs with aneurysmal venous outflows and in those AVMs with giant venous aneurysms.
Three patients suffered transient sciatic nerve injuries. One patient suffered an ipsilateral perineal numbness that also completely resolved. Four instances of perineal blistering and tissue injury with one injection, was treated uneventfully. One patient had a rectal wall injury requiring bowel diversion, and after healing, underwent re-anastamosis. One elderly patient died within 30 days of a 4th procedure from pulmonary embolus (PE). One patients coils eroded thru bladder wall and endoscopically removed. One patient had a small bleed that was self-limited not requiring transfusion.
Conclusions : Endovascular approaches to manage pelvic AVM have proven to be curative at long-term follow-up. In our cases, surgery adjunctively to remove the AVM has not been required. Despite previous embolizations with coils, glue, Onyx, and surgical ligations prior to being referred to our institution, endovascular and direct puncture approaches using ethanol, ethanol and coils, has proven to curatively manage pelvic AVMs involving soft tissue and bone with low complication rates and no recurrences.