Severity: Warning
Message: file_get_contents(https://...@pubfacts.com&api_key=b8daa3ad693db53b1410957c26c9a51b4908): Failed to open stream: HTTP request failed! HTTP/1.1 429 Too Many Requests
Filename: helpers/my_audit_helper.php
Line Number: 144
Backtrace:
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 144
Function: file_get_contents
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 212
Function: simplexml_load_file_from_url
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 1002
Function: getPubMedXML
File: /var/www/html/application/helpers/my_audit_helper.php
Line: 3142
Function: GetPubMedArticleOutput_2016
File: /var/www/html/application/controllers/Detail.php
Line: 575
Function: pubMedSearch_Global
File: /var/www/html/application/controllers/Detail.php
Line: 489
Function: pubMedGetRelatedKeyword
File: /var/www/html/index.php
Line: 316
Function: require_once
Purpose: Through a paradigmatic case and a systematic literature review, we present various endovascular strategies for treating pelvic paravesical arteriovenous vascular malformations (AVMs), with a focus on the efficacy of accessing the shunt point through direct puncture of the venous collector.
Case Report: A 42-year-old male with nonspecific pelvic pain underwent a computed tomography (CT) scan, which revealed bilateral pelvic AVMs characterized by a network of arteriolar afferents originating from the internal iliac arteries and the inferior mesenteric artery, draining into 2 interconnected giant venous sacs in the bilateral paravesical space. The malformation was classified as type II according to the Cho classification. Following an unsuccessful attempt at transarterial embolization, we devised a plan for bilateral transvenous embolization in 2 separate sessions. Venous access was achieved through percutaneous transperineal ultrasound-guided puncture of the dominant outflow venous sac. A microcatheter was then placed directly into the shunt point, where sclerosant and embolic agents were specifically delivered. Follow-up imaging showed complete obliteration of both pelvic AVMs.
Conclusions: Effective hemostasis of pelvic paravesical AVMs can be achieved by targeting the shunt point from the aneurysmal dominant outflow vein, potentially through direct percutaneous puncture.
Clinical Impact: This study aims to demonstrate the effectiveness of a transvenous approach in cases of embolization of pelvic paravesical arteriovenous vascular malformations (AVMs). The key to successful treatment lies in occluding the shunt point within the aneurysmal dominant outflow vein's wall, which can be reached transvenously and potentially through direct percutaneous puncture. Although arterial occlusion can be performed additionally, it should not be performed alone due to its higher risk of AVM persistence/recurrence.
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Source |
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http://dx.doi.org/10.1177/15266028241267747 | DOI Listing |
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