title: Curative treatment of pelvic arteriovenous malformation--an alternative strategy: transvenous intra-operative embolisation.
abstract: OBJECTIVE
  Pelvic arteriovenous malformations (AVMs) are difficult to treat. Arterial embolisation is the most common strategy but often has poor results. We report an alternative surgical approach of controlled intra-operative transvenous embolisation with long-term results in seven cases.
  
  
  METHODS
  Between 1980 and 2008, we treated seven patients (four men, three women, mean age 50 years). Indications were rectal bleeding (one case), urinary tract problems (four cases), oedema of lower limb (one case) and high-output cardiac failure (one case). Four of them had previous operations and three had previous attempts for embolisation. Embolisation of the malformation was performed through the internal iliac vein. This was done after clamping of all the feeding and draining vessels. The agent used was cyanocrylate (one case), Ethibloc (one case) and bone wax (five cases).
  
  
  RESULTS
  Mortality was 0%. Complications occurred in two patients (28,5%), one pulmonary embolism and one regressive femoral paresis. Three patients were re-operated for various reasons. The mean follow-up period was 6 years (1-12 years). Symptoms resolved in all patients, while control by computed tomography (CT) angioscan revealed one residual shunt.
  
  
  CONCLUSIONS
  Complete surgical excision of pelvic AVMs is not always possible. Embolisation does not offer a permanent cure. Intra-operative transvenous embolisation of persisting complex AVMs appears to be an alternative approach with good immediate and long-term results. Ethylene glycol appears to be the most suitable agent.
authors.affiliation: Department of Vascular Surgery, Saint-Joseph Hospital, Paris, France. alexandrosmallios@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Mallios
authors.forename: C
authors.initials: C
authors.lastname: Laurian
authors.forename: R
authors.initials: R
authors.lastname: Houbballah
authors.forename: F
authors.initials: F
authors.lastname: Gigou
authors.forename: V
authors.initials: V
authors.lastname: Marteau
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D003487:Cyanoacrylates / Q000008:administration & dosage; D003973:Diatrizoate / Q000008:administration & dosage; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005227:Fatty Acids / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010168:Palmitates / Q000008:administration & dosage; D010297:Paris; D010388:Pelvis / Q000098:blood supply*; D011409:Propylene Glycols / Q000008:administration & dosage; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014885:Waxes; D015028:Zein / Q000008:administration & dosage
chemical_list: D003487:Cyanoacrylates; D004338:Drug Combinations; D005227:Fatty Acids; D010168:Palmitates; D011409:Propylene Glycols; D014885:Waxes; D003973:Diatrizoate; C055480:bone wax; D015028:Zein; C020481:alcoholic prolamine solution