9:03 AM; Abstract No. 106 - Ethanol embolotherapy management of pelvic arteriovenous malformation

Abstract

To determine the curative role of ethanol endovascular and/or ethanol coils in the treatment of large pelvic arteriovenous malformations (AVMs). Forty-eight 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 (Dehydrated alcohol injection, USP; American Regent, Inc.; Shirley, NY); Cook stainless steel and Nester fibered coils (Cook Inc.; Bloomington, IN), and Terumo Azur Hydrocoils (Terumo Europe; Leuven, Belgium). Early on, patients had overnight hospital stays; the last 12 years, however, patients are being observed four hours and then discharged. Thirty-six patients are cured of their pelvic AVM (mean follow-up: 43 months) and 12 patients’ treatments are on-going. Pelvic AVMs were cured by using ethanol or ethanol with coils. The addition of coils was particularly useful in those AVMs with enlarged venous outflows and in those AVMs with giant venous aneurysms. Equal efficacy is noted between Cook coils and Terumo Azur coils to treat pelvic AVMs. 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 patient died within 30 days of a 4th procedure from pulmonary embolus (PE). 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, and surgical ligations prior to being referred to our institution, endovascular and direct puncture approaches can successfully manage these lesions.