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Venturini M, Bergamini A, Colarieti A, et al. A rare case of a giant arterio-venous fistula (AVF) following metastatic choriocarcinoma conditioning pulmonary embolism: multimodal transcatheter embolization using a simultaneous transarterial and transvenous approach. CVIR Endovasc. 2018;1(1):30doi: 10.1186/s42155-018-0039-8.
Venturini, M., Bergamini, A., Colarieti, A., Petrone, M., Marra, P., Rabaiotti, E., Mangili, G., Candiani, M., Del Maschio, A., & De Cobelli, F. (2018). A rare case of a giant arterio-venous fistula (AVF) following metastatic choriocarcinoma conditioning pulmonary embolism: multimodal transcatheter embolization using a simultaneous transarterial and transvenous approach. CVIR endovascular, 1(1), 30. https://doi.org/10.1186/s42155-018-0039-8
Venturini, Massimo, et al. "A rare case of a giant arterio-venous fistula (AVF) following metastatic choriocarcinoma conditioning pulmonary embolism: multimodal transcatheter embolization using a simultaneous transarterial and transvenous approach." CVIR endovascular vol. 1,1 (2018): 30. doi: https://doi.org/10.1186/s42155-018-0039-8
Venturini M, Bergamini A, Colarieti A, Petrone M, Marra P, Rabaiotti E, Mangili G, Candiani M, Del Maschio A, De Cobelli F. A rare case of a giant arterio-venous fistula (AVF) following metastatic choriocarcinoma conditioning pulmonary embolism: multimodal transcatheter embolization using a simultaneous transarterial and transvenous approach. CVIR Endovasc. 2018;1(1):30. doi: 10.1186/s42155-018-0039-8. Epub 2018 Nov 20. PMID: 30652161; PMCID: PMC6319539.
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CVIR Endovasc. 2018;1(1):30. doi: 10.1186/s42155-018-0039-8. Epub 2018 Nov 20.

A rare case of a giant arterio-venous fistula (AVF) following metastatic choriocarcinoma conditioning pulmonary embolism: multimodal transcatheter embolization using a simultaneous transarterial and transvenous approach.

CVIR endovascular

Massimo Venturini, Alice Bergamini, Anna Colarieti, Micaela Petrone, Paolo Marra, Emanuela Rabaiotti, Giorgia Mangili, Massimo Candiani, Alessandro Del Maschio, Francesco De Cobelli

Affiliations

  1. Department of Radiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.
  2. 2Department of Gynaecology, San Raffaele Scientific Institute, Milan, Italy.
  3. 3Vita-Salute San Raffaele University, Milan, Italy.

PMID: 30652161 PMCID: PMC6319539 DOI: 10.1186/s42155-018-0039-8

Abstract

BACKGROUND: Choriocarcinoma is a highly malignant tumor but with a good prognosis due to the valid response to systemic chemotherapy. We present a case of a young woman affected by a giant pelvic arterio-venous fistula following a metastatic gestational choriocarcinoma, conditioning metrorrhagia and pulmonary embolism, successfully treated by multimodal transcatheter embolization, using a simultaneous transarterial and transvenous approach.

CASE PRESENTATION: In a young patient affected by choriocarcinoma and metrorrhagia, a computed tomography showed a giant arterio-venous fistula, pulmonary metastases and embolism. A transfemoral diagnostic arteriography showed a giant arterio-venous fistula sustained by right and left hypogastric arteries with early opacification of the right gonadal vein and of the inferior vena cava. A transarterial embolization of the distal branches of hypogastric arteries with poly-vinyl-alcohol particles, coils and Squid was performed. A transfemoral phlebography of the right gonadal vein showed multiple thrombi, responsible of the pulmonary embolism. An Amplatzer plug via trans-jugular was finally placed at the confluence of the gonadal vein in the vena cava, to reduce arterio-venous fistula out-flow and to occlude the vein, preventing further episodes of pulmonary embolism. Metrorrhagia progressively disappeared. A second transarterial embolization combined with a complete response to systemic chemotherapy determined arterio-venous fistula resolution.

CONCLUSIONS: This was a very rare case of a giant pelvic arterio-venous fistula following choriocarcinoma in a patient symptomatic for metrorrhagia with an accidental finding of pulmonary embolism at computed tomography. A transcatheter embolization was successfully performed with different embolic materials, using a simultaneous transarterial and transvenous approach: the goal was not only to obtain metrorrhagia resolution but also to avoid a massive pulmonary embolism, a potential life threatening condition, in a young woman affected by a highly malignant tumor but with a good prognosis.

Keywords: Amplatzer vascular plug; Arteriovenous fistula; Choriocarcinoma metastases; Embolic agents; Embolization; Pulmonary embolism

Conflict of interest statement

Institutional review board approval was not required because of the retrospective nature of the work.Not applicable.The authors declare that they have no competing interests.Springer Nature remains ne

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