A New Therapeutic Approach to Congenital Pelvic Arteriovenous Malformations

Background: Internal iliac arteriovenous malformations (AVM) are difficult to treat. Arterial embolization is chosen in most cases but the angio-architecture of these arteriovenous shunts can provide an explanation for the several reported failures. We report the long-term results of peroperative intravenous embolization. Methods: Between the years 1980 and 2008, seven patients were treated for complex and symptomatic internal AVM. These patients underwent a surgery which involved massive embolization of the venous hypogastric compartment, followed by the ligation of the hypogastric vein at its origin. Results: There were no deaths reported in this group. The mean follow-up was 7 years (range: 10 months-12 years), with no cases of recurrences found. Computed tomographic scans of controls with reconstruction did not show any residual arteriovenous shunts. Conclusion: Intravenous embolization of the internal iliac AVM is a therapeutic strategy which is well adapted to the special angio-architecture of the arteriovenous shunts. Clinical and anatomic results have confirmed the validity of this strategy.