Treatment of a pelvic arteriovenous malformation by stent graft placement combined with sclerotherapy

Contrast-enhanced computed tomography scan showed (A) a compressed left external iliac vein (arrow), (B) multiple fine striations at the left pelvic cavity with abnormal arterial enhancement of the left external iliac vein (arrow) on arterial dominant phase, and (C) a compressed left common iliac vein (arrow) by the left common iliac artery. D, Aortography showed a vascular blush between the left internal iliac artery and left external iliac vein connected by fine multiple shunts. E, On late arterial phase, focal stenosis was noted at the proximal segment of left external iliac vein (arrow), with multiple pelvic collateral vessels. F, An oblique aortography showed a focal filling defect at the left common iliac vein (arrow), suggesting extrinsic compression by the left common iliac artery.

A, B, A stent graft and stent were deployed within the left external iliac vein extended to the common iliac vein. C, Collapsed stent graft was noted after 1 week, and (D) an additional stent was deployed within the external iliac vein, overlapping the preexisting stent graft. E, An intra-arterial ethanol injection was performed using a microcatheter. A normal gluteal branch (arrow) was embolized using microcoils before the ethanol injection to avoid unwanted sclerotherapy.

A follow-up computed tomography scan at 6 month showed no opacification of the pelvic arteriovenous malformation and a patent stent graft.