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DOI: 10.1055/a-1388-6021
Rendezvous therapy with endoscopic and endovascular treatments for rectal arteriovenous malformation: A case report
An 84-year-old man was admitted to our hospital with recurring hematochezia. Six months earlier, he had undergone transcatheter arterial embolization using platinum coils for hemorrhagic rectal arteriovenous malformation.
Contrast-enhanced computed tomography (CT) revealed a recurrence of the rectal arteriovenous malformation ([Fig. 1]), and colonoscopy revealed erosion with pulsation in the lower rectum ([Fig. 2]). The diagnosis was rectal arteriovenous malformation rebleeding, which is typically treated using transcatheter arterial embolization and surgical resection [1] [2] [3]. However, transcatheter arterial embolization alone does not eliminate the abnormal vessels, and surgical resection was considered too invasive because of the patient’s advanced age. Therefore, a less invasive curative therapy was attempted to control bleeding from the malformation using a combination of endoscopic injection sclerotherapy with n-butyl cyanoacrylate-lipiodol and endovascular therapy with balloon catheters ([Video 1]).
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Video 1 A combination of endoscopic injection sclerotherapy with n-butyl cyanoacrylate-lipiodol mixture and endovascular therapy with balloon catheters for bleeding from a rectal arteriovenous malformation.
Qualität:
A 1.9-Fr catheter was initially advanced to the inferior mesenteric artery via a percutaneous approach, and arteriography revealed typical arteriovenous malformation findings (abnormal vessels called a “nidus” in the arterial phase and early venous return in the capillary phase). A 2.7-Fr balloon catheter was then advanced to the superior rectal vein via a percutaneous transhepatic approach to occlude it and prevent the migration of n-butyl cyanoacrylate-lipiodol into the portal vein. Colonoscopy subsequently revealed spurting bleeding from the rectal erosion. To control the hemorrhage, the 1.9-Fr catheter was exchanged for a 2.7-Fr balloon catheter, and balloon occlusion of the inferior mesenteric artery resulted in temporary hemostasis. We injected 3 mL of 50 % n-butyl cyanoacrylate-lipiodol using a 23-G needle directly at the bleeding point under balloon flow control of both the superior rectal vein and inferior mesenteric artery, and we observed successful n-butyl cyanoacrylate-lipiodol accumulation in the nidus under fluoroscopy.
Follow-up contrast-enhanced CT 1 month later revealed the disappearance of the nidus and a dilated vein draining the arteriovenous malformation ([Fig. 3]); colonoscopy revealed only minor artificial erosion without pulsation ([Fig. 4]).
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Competing interests
The authors declare that they have no conflict of interest.
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References
- 1 Mallios A, Laurian C, Houbballah R. et al. Curative treatment of pelvic arteriovenous malformation – an alternative strategy: transvenous intra-operative embolisation. Eur J Vasc Endovasc Surg 2011; 41: 548-553
- 2 Ishikawa S, Mukai S, Hirata Y. et al. Rectal arteriovenous malformation treated by transcatheter arterial embolization. Case Rep Gastroenterology 2020; 14: 7-14
- 3 Hayakawa H, Kusagawa M, Takahashi H. et al. Arteriovenous malformation of the rectum: report of a case. Surg Today 1998; 28: 1182-1187
Corresponding author
Publikationsverlauf
Artikel online veröffentlicht:
15. März 2021
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References
- 1 Mallios A, Laurian C, Houbballah R. et al. Curative treatment of pelvic arteriovenous malformation – an alternative strategy: transvenous intra-operative embolisation. Eur J Vasc Endovasc Surg 2011; 41: 548-553
- 2 Ishikawa S, Mukai S, Hirata Y. et al. Rectal arteriovenous malformation treated by transcatheter arterial embolization. Case Rep Gastroenterology 2020; 14: 7-14
- 3 Hayakawa H, Kusagawa M, Takahashi H. et al. Arteriovenous malformation of the rectum: report of a case. Surg Today 1998; 28: 1182-1187
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