title: Laparotomized direct puncture for embolization of a retroperitoneal arteriovenous fistula.
abstract: 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.
authors.affiliation: Department of Radiology, Niigata University Medical and Dental Hospital, Chuo-ku, Niigata, Japan. sinagawa@med.niigata-u.ac.jp
authors.forename: Shoichi
authors.initials: S
authors.lastname: Inagawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Unno
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yamashita
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Harumi
authors.initials: H
authors.lastname: Sakahara
mesh_terms: 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
chemical_list: D004659:Enbucrilate