胸壁に生じた巨大AVMに対してモノエタノールアミンオレイン酸塩を用いた塞栓-硬化療法が奏効した1例

Successful Treatment of a Large Arteriovenous Malformation by Embolization-sclerotherapy with Ethanolamine Oleate

はじめに

　動静脈奇形（arteriovenous malformation：以下，AVM）は病勢の進行に伴って疼痛の増強や組織壊死を生じ，ひいては心不全に至る可能性のある疾患である。特に巨大なAVMでは，病変に流入する血流の多さと治療の困難さから心不全に進展する可能性が高い。また，躯幹に生じた病変の手術では，四肢のように術中の止血帯による出血コントロールができない。このため，切除手術の際に出血コントロールに難渋するリスクが高い。今回著者らは，躯幹の筋層に生じた広範囲AVMを塞栓-硬化療法を用いて治療し，ほぼ満足する結果を得たので，若干の文献的考察を加えて報告する。

　Since tourniquets cannot be used for trunk arteriovenous malformations (AVMs) as in the limbs, surgical AVM excision may cause uncontrollable bleeding. In particular, huge AVMs in the trunk are often difficult to resect due to the risk of severe hemorrhage and large tissue loss. A woman presented to our clinic due to increasing back pain. Contrast enhanced computed tomography revealed a large AVM of approximately 15 x 14 x 4 cm in the intermuscular area of the back, leading to a diagnosis of stage 3 AVM. Embolization-sclerotherapy in cooperation with interventional radiologists was planned. She underwent transcatheter n-butyl 2-cyanoacrylate embolization as flow control and percutaneous direct embolization with monoethanolamine oleate. Two days later, she received sclerotherapy with ethanol on her back. Her pain gradually subsided after treatment without sequalae. Although monoethanolamine oleate has mainly been reported for such low-flow vascular malformations as venous malformations, this agent could effectively fill the patientʼs huge AVM with adequate flow control. In conclusion, embolization-sclerotherapy without excision by integrated multi-disciplinary teams enabled the safe and successful treatment of a large trunk AVM.