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

• Published in: CVIR endovascular 2018-11, Vol.1 (1), p.30-30, Article 30
• Main Authors: Venturini, Massimo, Bergamini, Alice, Colarieti, Anna, Petrone, Micaela, Marra, Paolo, Rabaiotti, Emanuela, Mangili, Giorgia, Candiani, Massimo, Del Maschio, Alessandro, De Cobelli, Francesco
• Format: Article
• Language: English
• Subjects: Amplatzer vascular plug; Arteriovenous fistula; Case Report; Chemotherapy; Choriocarcinoma metastases; Embolic agents; Embolisms; Embolization; Fistula; Health risk assessment; Imaging; Interventional Radiology; Medicine; Medicine & Public Health; Metastasis; Pulmonary embolism; Pulmonary embolisms; Radiology; Veins & arteries
• ISSN: 2520-8934; 2520-8934
• DOI: 10.1186/s42155-018-0039-8

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.