A rare case of a giant arterio-venous fistula (AVF) following metastatic choriocarcinoma conditioning pulmonary embolism: multimodal transcatheter embolization using a simultaneous transarterial and transvenous approach

被引：2

作者：

Venturini M. ^{[1
]}

Bergamini A. ^{[2
]}

Colarieti A. ^{[1
]}

Petrone M. ^{[2
]}

Marra P. ^{[1
]}

Rabaiotti E. ^{[2
]}

Mangili G. ^{[2
]}

Candiani M. ^{[2
,3
]}

Del Maschio A. ^{[1
,3
]}

De Cobelli F. ^{[1
,3
]}

机构：

[1] Department of Radiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, Milan

[2] Department of Gynaecology, San Raffaele Scientific Institute, Milan

[3] Vita-Salute San Raffaele University, Milan

来源：

CVIR Endovascular | / 1卷 / 1期

关键词：

Amplatzer vascular plug; Arteriovenous fistula; Choriocarcinoma metastases; Embolic agents; Embolization; Pulmonary embolism;

D O I：

10.1186/s42155-018-0039-8

中图分类号：

学科分类号：

摘要：

Background: Choriocarcinoma is a highly malignant tumor but with a good prognosis due to the valid response to systemic chemotherapy. We present a case of a young woman affected by a giant pelvic arterio-venous fistula following a metastatic gestational choriocarcinoma, conditioning metrorrhagia and pulmonary embolism, successfully treated by multimodal transcatheter embolization, using a simultaneous transarterial and transvenous approach. Case presentation: In a young patient affected by choriocarcinoma and metrorrhagia, a computed tomography showed a giant arterio-venous fistula, pulmonary metastases and embolism. A transfemoral diagnostic arteriography showed a giant arterio-venous fistula sustained by right and left hypogastric arteries with early opacification of the right gonadal vein and of the inferior vena cava. A transarterial embolization of the distal branches of hypogastric arteries with poly-vinyl-alcohol particles, coils and Squid was performed. A transfemoral phlebography of the right gonadal vein showed multiple thrombi, responsible of the pulmonary embolism. An Amplatzer plug via trans-jugular was finally placed at the confluence of the gonadal vein in the vena cava, to reduce arterio-venous fistula out-flow and to occlude the vein, preventing further episodes of pulmonary embolism. Metrorrhagia progressively disappeared. A second transarterial embolization combined with a complete response to systemic chemotherapy determined arterio-venous fistula resolution. Conclusions: This was a very rare case of a giant pelvic arterio-venous fistula following choriocarcinoma in a patient symptomatic for metrorrhagia with an accidental finding of pulmonary embolism at computed tomography. A transcatheter embolization was successfully performed with different embolic materials, using a simultaneous transarterial and transvenous approach: the goal was not only to obtain metrorrhagia resolution but also to avoid a massive pulmonary embolism, a potential life threatening condition, in a young woman affected by a highly malignant tumor but with a good prognosis. © 2018, The Author(s).

引用

共 11 条

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