Figure 18.

Combined transarterial and transvenous approaches to arteriovenous malformation (AVM) treatment. (A) Large left pelvic AVM with dilated hypertrophied arterial feeders (white asterisk) leading to very large nidus (hollow asterisk) and then onto massively dilated internal iliac venous drainage (black asterisk). Early phase (B) and late phase (C) internal iliac angiogram of AVM through transarterial coaxial catheter system (arrows) for diagnostic arterial monitoring and access for subselective embolosclerotherapy. A second coaxial retrograde venous catheter (arrowheads) lies within the massively dilated venous nidus. A third retrograde venous sheath lies near the entrance to the left internal iliac vein (curved arrow) for future iliac occlusion. (D) Final diagnostic angiogram after deposition of multiple coils, glue, transarterial and transvenous ethanol revealing complete elimination of the nidus and no evidence of arteriovenous shunt (hollow circle).