Curative Treatment of Pelvic Arteriovenous Malformation - An Alternative Strategy: Transvenous Intra-operative Embolisation
Curative Treatment of Pelvic Arteriovenous Malformation - An Alternative Strategy: Transvenous Intra-operative Embolisation
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DOI：
10.1016/j.ejvs.2010.11.018
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发表时间：
2011-04-01
影响因子：
5.7
通讯作者：
Marteau, V.
中科院分区：
文献类型：
--
作者：
Mallios, A.;Laurian, C.;Marteau, V.
目的：骨盆动静脉畸形（AVMs）是一种较难治疗的畸形。动脉栓塞是最常见的策略，但往往效果不佳。我们报告了一种控制术中经静脉栓塞的替代手术方法，其长期效果为7例。材料和方法：1980 - 2008年间，我们治疗了7例患者（男4例，女3例，平均年龄50岁）。适应症为直肠出血（1例）、泌尿道问题（4例）、下肢水肿（1例）、高输出心力衰竭（1例）。其中4人以前做过手术，3人以前尝试过栓塞。通过髂内静脉栓塞畸形。这是在夹紧所有喂养和排泄血管后完成的。所用药物为氰基丙烯酸酯（1例）、Ethibloc（1例）、骨蜡（5例）。结果：死亡率为0%。2例患者出现并发症（28.5%），1例肺栓塞，1例退行性股瘫。3例患者因各种原因再次手术。平均随访6年（1 ~ 12年）。所有患者的症状都消失了，而通过计算机断层扫描（CT）血管扫描发现一个残留的分流。结论：骨盆动静脉畸形的完全手术切除并不总是可行的。栓塞术并不能永久治愈。术中经静脉栓塞治疗顽固性复杂动静脉畸形似乎是一种具有良好即时和长期效果的替代方法。乙二醇似乎是最合适的药剂。(C) 2010年欧洲血管外科学会。Elsevier Ltd.出版。版权所有。
Objectives: 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 ernbolisation with long-term results in seven cases.Materials and 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.Conclusion: 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. (C) 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.