Surgical resection of a large recurrent pelvic arteriovenous malformation using deep hypothermic circulatory arrest.

Transcatheter embolization has emerged as the treatment of choice for pelvic arteriovenous malformations (AVMs), because surgical resection may be difficult and is associated with a high recurrence rate. We report a patient with a large recurrent pelvic AVM in whom transcatheter embolization was not feasible. This patient underwent surgical resection of the AVM, which was accomplished with deep hypothermic circulatory arrest. Early postoperative angiography demonstrated a small amount of residual AVM, which was successfully embolized with microcoils. Follow-up magnetic resonance angiography at 2 months showed no residual AVM. In cases where surgical resection of an extensive AVM is required, deep hypothermic circulatory arrest offers the distinct advantages of performing the resection in a bloodless field and enabling adequate visualization of important adjacent structures.