ハイブリッド治療にてアルコール硬化を施行したが術後に出血を繰り返した右鼠径部動静脈奇形の1例

A Right Inguinal Arteriovenous Malformation with Repeated Bleeding After Hybrid Treatment

はじめに

　体幹の動静脈奇形（arteriovenous malformation：以下，AVM）は四肢のAVMと比較すると，ターニケットが使用できないので出血コントロールが難しい 1）。

　今回，下腹部AVM全切除後8年に再発した右鼠径部巨大AVMに対し，外科手技と血管内手技とのハイブリッド治療にて明視野での病変部クランプ駆血とsegmentation下のエタノール硬化を行ったが，術後に出血を繰り返し小康を得るまでに難渋した症例を経験したため報告する。

　Bleeding control in arteriovenous malformations (AVMs) of the trunk is more difficult than in AVMs of the extremities. We present the case details of a 25-year-old male with an AVM in the right inguinal region. The AVM recurred 8 years after its total resection and was treated by hybrid treatment, i.e., interventional radiology and surgery. However, repeated postoperative hemorrhagic events occurred and were difficult to resolve. The patient underwent self-interrupted treatment approx. 15 months after the initial surgery. Early intervention, and presumably a better outcome, might have been possible with continued follow-up.