1
|
Ji L, Gu G, Liu Z, Chen Y, Ye W, Liu B, Liu C, Zheng Y. Clinical Features and Endovascular Management of Iliac Arteriovenous Fistulas: A 10-Year Single Center Experience. Front Surg 2022; 9:873665. [PMID: 35495752 PMCID: PMC9046574 DOI: 10.3389/fsurg.2022.873665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveIliac arteriovenous fistulas (IAVFs) are rare abnormalities with limited reported cases. This study aimed to summarize the clinical features and experiences on the diagnosis and endovascular treatment of IAVFs.MethodsA single-center retrospective study of IAVFs from 2010 to 2019 was performed. Data including demographics, clinical characteristics, radiological images, surgical details, and follow-up were collected.ResultsA total of 16 patients diagnosed with IAVFs were identified. The female to male ratio was 3:1. The mean age was 47.7 ± 10.4 years (range: 35–73 years). Leg swelling and cardiac insufficiency, especially heart failure, were the most common primary symptoms in this series, which were revealed in 68.8 and 37.5% of patients, respectively. Iatrogenic, traumatic, and congenital IAVFs were diagnosed in 62.5, 12.5, and 25.0% of patients, respectively, among which hysterectomy was thought to be the main cause for female iatrogenic IAVFs (31.3%). Anatomic analysis found that internal iliac vessels were the predilected sites of IAVFs. All the patients were treated by endovascular procedures composed of transarterial embolization (50.0%), transarterial and stage II transvenous embolization (31.3%), stage I transarterial and transvenous embolization (12.5%), and transarterial embolization plus stent implantation (6.3%). The clinical success rate was 93.8%. Minor complications including fever (18.8%) and exudation at the puncture point (6.25%) were noted and well-treated. During a follow-up period of 51.3 ± 41.9 months after operations, only one patient experienced re-emergence of heart failure because of recurrence of leiomyosarcoma; other patients recovered uneventfully with symptoms relief and no severe embolization-related complications was encountered.ConclusionIAVFs are rare disorders and correct diagnosis requires careful history taking and physical examination, combined with proper imaging investigation. The primary goal for treatment of IAVFs was to relieve associated symptoms. Based on the results of this study, endovascular approach is safe and effective for treatment of IAVFs.
Collapse
Affiliation(s)
- Lei Ji
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Vascular Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Guangchao Gu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhili Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuexin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Ye
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changwei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yuehong Zheng
| |
Collapse
|
2
|
Accuracy of flow-void diameters on MR images in diagnosing uterine arteriovenous malformations in patients with pregnancy-related diseases. Sci Rep 2021; 11:19806. [PMID: 34615908 PMCID: PMC8494937 DOI: 10.1038/s41598-021-99209-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022] Open
Abstract
To evaluate the “flow void” diameter in patients with pregnancy-related diseases with and without uterine AVMs and assess the diagnostic performance of unenhanced MRI for uterine AVMs. From May 2014 to April 2019, 79 patients with pregnancy-related diseases were included, including 36 with and 43 without uterine AVMs confirmed by DSA. On MRI, the diameter of the most prominent “flow void” (hereinafter referred to as fv-D) was measured and compared between patients with and without uterine AVMs. The diagnostic performance of fv-D was estimated with receiver operating characteristic curves. The “flow void” sign was observed in patients with and without uterine AVMs (P > 0.05). The fv-D was significantly larger in patients with uterine AVMs in the myometrium and parametrium than in patients without uterine AVMs (P < 0.0001). The fv-D achieved a reliable diagnostic performance in the myometrium (sensitivity 80.6%, specificity 60.5%, negative predictive value 78.8%, positive predictive value 63%, AUC 0.727, cut-off: > 1.33 mm) and parametrium (sensitivity 97.2%, specificity 67.4%, negative predictive value 96.7%, positive predictive value 71.4%, AUC 0.881, cut-off > 2.6 mm). On MRI, fv-D could diagnose uterine AVMs. The fv-D had a much higher diagnostic efficiency in the parametrium than in the myometrium. The parametrium fv-D greatly improved the diagnostic sensitivity and provides a more accurate, noninvasive method of investigating possible uterine AVMs.
Collapse
|
3
|
Dahl JS, Andersen C, Duvnjak S, Moller JE. Two cases of high-output heart failure as initial presentation of iliac arteriovenous fistula. BMJ Case Rep 2018; 2018:bcr-2018-225659. [PMID: 30007907 DOI: 10.1136/bcr-2018-225659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present two cases of females in their 40s presenting with biventricular heart failure being the consequence of a large arteriovenous fistula. Both patients had undergone abdominal surgery several years prior to the heart failure event with the initial finding of moderate pulmonary hypertension and high-output heart failure. CT revealed a large arteriovenous fistula between the common iliac artery and vein which subsequently was closed percutaneously.
Collapse
Affiliation(s)
- Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Claus Andersen
- Department of Anesthesiology, Odense University Hospital, Odense, Denmark
| | - Stevo Duvnjak
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | |
Collapse
|
4
|
Yoon DJ, Jones M, Taani JA, Buhimschi C, Dowell JD. A Systematic Review of Acquired Uterine Arteriovenous Malformations: Pathophysiology, Diagnosis, and Transcatheter Treatment. AJP Rep 2016; 6:e6-e14. [PMID: 26929872 PMCID: PMC4737639 DOI: 10.1055/s-0035-1563721] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/15/2015] [Indexed: 12/11/2022] Open
Abstract
Objective An acquired uterine arteriovenous malformation (AVM) is a rare cause of vaginal bleeding and, although hysterectomy is the definitive therapy, transcatheter embolization (TCE) provides an alternative treatment option. This systematic review presents the indications, technique, and outcomes for transcatheter treatment of the acquired uterine AVMs. Study Design Literature databases were searched from 2003 to 2013 for eligible clinical studies, including the patient characteristics, procedural indication, results, complications, as well as descriptions on laterality and embolic agents utilized. Results A total of 40 studies were included comprising of 54 patients (average age of 33.4 years). TCE had a primary success rate with symptomatic control of 61% (31 patients) and secondary success rate of 91% after repeated embolization. When combined with medical therapy, symptom resolution was noted in 48 (85%) patients without more invasive surgical procedures. Conclusion Low-level evidence supports the role of TCE, including in the event of persistent bleeding following initial embolization, for the treatment of acquired uterine AVMs. The variety of embolic agents and laterality of approach delineate the importance of refining procedural protocols in the treatment of the acquired uterine AVM. Condensation A review on the management of patients with acquired uterine AVMs.
Collapse
Affiliation(s)
- Daniel J Yoon
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Megan Jones
- Department of Obstetrics and Gynecology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jamal Al Taani
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Catalin Buhimschi
- Department of Obstetrics and Gynecology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Joshua D Dowell
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| |
Collapse
|
5
|
Hasegawa A, Sasaki H, Wada-Hiraike O, Osuga Y, Yano T, Usman SM, Akahane M, Kozuma S, Taketani Y. Uterine Arteriovenous Fistula Treated With Repetitive Transcatheter Embolization: Case Report. J Minim Invasive Gynecol 2012; 19:780-4. [DOI: 10.1016/j.jmig.2012.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 07/09/2012] [Accepted: 07/12/2012] [Indexed: 10/27/2022]
|