Successful percutaneous transgluteal embolization of a complex arteriovenous malformation feeding a hypogastric artery aneurysm Matteo Ripepi, MD, Gianfranco.

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Successful percutaneous transgluteal embolization of a complex arteriovenous malformation feeding a hypogastric artery aneurysm Matteo Ripepi, MD, Gianfranco Varetto, MD, Lorenzo Gibello, MD, Maria Antonella Ruffino, MD, Paolo Fonio, MD, PhD, Pietro Rispoli, MD, PhD Journal of Vascular Surgery Cases and Innovative Techniques Volume 4, Issue 1, Pages 45-49 (March 2018) DOI: 10.1016/j.jvscit.2017.12.007 Copyright © 2018 The Authors Terms and Conditions

Fig 1 A-C, Computed tomography axial scans show a pelvic arteriovenous malformation (AVM) feeding a hypogastric artery aneurysm (HAA). D, Three-dimensional reconstruction of the pelvic AVM. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 45-49DOI: (10.1016/j.jvscit.2017.12.007) Copyright © 2018 The Authors Terms and Conditions

Fig 2 A and B, A posterior-anterior view of aortic angiogram shows hypertrophic right lumbar arteries and ipsilateral inferior epigastric artery feeding the arteriovenous malformation (AVM). C and D, Oblique views: hypertrophic contralateral hypogastric branches feeding the AVM. The arrow indicates the right external gluteal artery arising from the hypogastric aneurysm. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 45-49DOI: (10.1016/j.jvscit.2017.12.007) Copyright © 2018 The Authors Terms and Conditions

Fig 3 A and B, Diagrams showing placement of the patient and vascular percutaneous accesses at the beginning of the procedure and after repositioning. 1, Left jugular access. 2, Direct transgluteal access. 3, Left common femoral artery access. 4, Arteriovenous malformation (AVM) localization. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 45-49DOI: (10.1016/j.jvscit.2017.12.007) Copyright © 2018 The Authors Terms and Conditions

Fig 4 A-C, Intraoperative angiograms showing (A) direct puncture of the right gluteal artery, (B) inflation of an occlusion balloon in the right internal iliac vein, and (C) final control demonstrating complete exclusion of the arteriovenous malformation (AVM) and right hypogastric artery aneurysm (HAA) with coils and glue. D, Six-month three-dimensional reconstruction of computed tomography images showing the absence of hypogastric aneurysm reperfusion or recurrence of AVM. Journal of Vascular Surgery Cases and Innovative Techniques 2018 4, 45-49DOI: (10.1016/j.jvscit.2017.12.007) Copyright © 2018 The Authors Terms and Conditions