The pre-operative embolisation of vascular malformations

Large arteriovenous malformations frequently require surgical excision in order to prevent or treat the potentially serious problems they can cause ranging from haemorrhage and pain to cardiac failure. The surgery itself is usually difficult and often dangerous due to the serious risk of major intraoperative haemorrhage. Transcatheter arterial embolisation has greatly facilitated the management of small arteriovenous malformations but may only afford temporary relief of symptoms in very large lesions. Recanalisation of occluded vessels and revascularisation via previously insignificant collateral vessels means that large lesions cannot be effectively managed by this method alone. Previous surgery and ligation of feeding vessels may make effective embolisation difficult or impossible and a combined radiological and surgical approach to these lesions may permit definitive treatment. We present three cases in whom the pre-operative embolisation of buttock arteriovenous malformations facilitated successful surgical excision.