Zabicki Bartosz, Holstad Marte Johanne V, Limphaibool Nattakarn, Juszkat Robert
Department of Diagnostic and Interventional Radiology, University Hospital No 1, Poznan University of Medical Sciences , Poland.
University Hospital Zielona Góra, Poland.
Pol J Radiol. 2019 May 27;84:e258-e261. doi: 10.5114/pjr.2019.86893. eCollection 2019.
Congenital pelvic arteriovenous malformations (AVMs) are high-flow vascular lesions consisting of abnormal shunts between arteries and veins within a nidus. The rare presentation and extensive network of vasculature contributes to the difficulty in effective treatment. Optimal therapeutic options are determined based on the clinical presentation, the location of the lesion, and possible complications.
A 24-year-old male patient with a history of recurrent pain following sexual intercourse presented with complaints of intense pelvic pain radiating to the perineal area. Computed tomography angiography (CTA) revealed a large venous aneurysm as an outflow vein of a right-sided pelvic AVM. Embolisation of the outflow veins was established along with direct percutaneous delivery of fibre coils and thrombin to the venous aneurysm of the AVM. With recurring symptoms and AVM recanalisation on angiography, another direct puncture and placement of pushable coils was made. Total AVM occlusion was achieved with no recanalisation on follow-up digital subtraction angiography (DSA), and the patient remained asymptomatic.
Endovascular embolisation of the nidus area may result in a complete occlusion of an AVM. Therefore, a thorough understanding of the vascular anatomy of the AVM is essential in choosing an effective embolisation strategy and to minimise the risk of possible complications.
先天性盆腔动静脉畸形（AVM）是一种高流量血管病变，由病灶内动脉与静脉之间的异常分流组成。其罕见的表现形式和广泛的血管网络导致有效治疗困难。最佳治疗方案需根据临床表现、病变位置及可能的并发症来确定。
一名24岁男性患者，有性交后反复疼痛病史，现主诉剧烈盆腔疼痛放射至会阴区。计算机断层血管造影（CTA）显示一个大的静脉瘤，为右侧盆腔AVM的流出静脉。对流出静脉进行栓塞，并经皮直接向AVM的静脉瘤内输送纤维圈和凝血酶。因症状复发且血管造影显示AVM再通，再次进行直接穿刺并置入可推送线圈。随访数字减影血管造影（DSA）显示AVM完全闭塞且无再通，患者保持无症状。
病灶区域的血管内栓塞可能导致AVM完全闭塞。因此，全面了解AVM的血管解剖结构对于选择有效的栓塞策略及将可能的并发症风险降至最低至关重要。
