Laparotomized direct puncture for embolization of a retroperitoneal arteriovenous fistula.
A 28-year-old woman was referred to our institution with hope for another child after having an abortion several months previously to avoid a potential risk of catastrophic hemorrhage from a retroperitoneal arteriovenous fistula (AVF) with enlarged and twisted draining veins in the pelvis. Multiple branches coming from the right lumbar arteries and the right iliac arteries fed fistulae converging on an enlarged venous pouch anterior to the psoas major muscle in the right retroperitoneal space. It seemed impossible to achieve complete occlusion of the lesion in a single session by either transarterial or transvenous approach. A laparotomy and direct puncture of the enlarged draining vein immediately downstream of the venous pouch was performed and embolization was done with n-butyl cyanoacrylate and the aid of coils. Complete occlusion of the retroperitoneal AVF was achieved and confirmed in control angiography 5 months later.
Inagawa
Shoichi
S
Department of Radiology, Niigata University Medical and Dental Hospital, Chuo-ku, Niigata, Japan. sinagawa@med.niigata-u.ac.jp
Unno
Naoki
N
Yamashita
Shuhei
S
Tanaka
Hiroki
H
Sakahara
Harumi
H
D000328:Adult; D000792:Angiography; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000002:abnormalities*; D007084:Iliac Vein / Q000002:abnormalities*; D007813:Laparotomy / Q000379:methods*; D016658:Psoas Muscles / Q000098:blood supply*; D011677:Punctures / Q000379:methods*; D012187:Retroperitoneal Space
D004659:Enbucrilate