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Arteriovenous fistulae of the internal iliac vessels
Insights
This study reports on seven patients with internal iliac artery arteriovenous fistulae, primarily congenital malformations. Combined embolization and surgery offer good results, though recurrence is possible.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Diagnostic Imaging
Background:
- Arteriovenous fistulae (AVF) of the internal iliac artery are rare vascular malformations.
- Congenital and post-traumatic etiologies are observed, presenting with varied symptoms including pain, edema, and bleeding.
Observation:
- Seven patients (ages 6-50) with internal iliac artery AVF were analyzed.
- Clinical presentations included cutaneous angiomata, leg edema, pain, and bleeding; only one patient was asymptomatic.
- Cardiac insufficiency was noted in one patient.
Findings:
- Six lesions were congenital malformations; one was post-traumatic.
- Diagnostic tools included arteriography, intravenous pyelography, and pelvic computed tomography.
- Combined embolization and urgent surgery (within 24 hours) were employed, with repeat embolization for recurrence.
Implications:
- The combined embolization and surgical approach demonstrated good outcomes in most patients.
- Recurrence was observed in two patients, highlighting the need for vigilant follow-up.
- Pelvic CT is a valuable recent addition to the diagnostic armamentarium for these complex lesions.
Abstract:
Seven patients with arteriovenous fistulae of the internal iliac artery are reported. Ages varied from 6 to 50 years (mean 32 years). Cutaneous angiomata , leg oedema and pain was present in 4 cases each, bleeding in 2 cases whilst only one was asymptomatic. Only 1 patient had cardiac insufficiency. In six patients the lesion was a congenital malformation but in one it was posttraumatic. Arteriography both global and selective, intravenous pyelography and cardiac output are routine. Recently, pelvic computerised tomography has been most helpful. Embolization is recommended in all cases with surgery within 24 hours unless the lesion is very extensive and considered to be inoperable. Repeat embolization is used for recurrence or very extensive lesions. Results were good in five patients; in two patients the results were clinically good but control angiograms showed a recurrence.