The pre-operative embolisation of vascular malformations

Area of Science:

• Vascular Surgery
• Interventional Radiology

Background:

• Large arteriovenous malformations (AVMs) pose significant risks, including hemorrhage and cardiac failure, often necessitating surgical excision.
• Surgical removal of AVMs is challenging due to the high risk of intraoperative bleeding.
• Transcatheter arterial embolisation is effective for small AVMs but offers only temporary relief for large or complex lesions.

Observation:

• Large AVMs can recur or revascularize through collateral vessels after embolisation alone.
• Previous surgical interventions or vessel ligations can complicate subsequent embolisation attempts.
• A combined radiological and surgical strategy may be necessary for definitive treatment of complex AVMs.

Findings:

• Pre-operative embolisation significantly facilitated surgical excision in three cases of buttock AVMs.
• This multimodal approach enabled successful management of previously challenging lesions.
• The study demonstrates the utility of combining embolisation with surgery for complex AVMs.

Implications:

• Pre-operative embolisation can be a crucial step in the multidisciplinary management of large arteriovenous malformations.
• Combining embolisation with surgical excision offers a potentially definitive treatment option for complex AVMs.
• This approach may reduce surgical risks and improve long-term outcomes for patients with large AVMs.