753 - Pelvic High-Flow Arteriovenous Malformations: 20-Year-Experience of a High-Volume, Tertiary Academic Institution

Learning Objectives: This educational exhibit aims to enhance understanding of pelvic high-flow arteriovenous malformations (AVMs), providing essential information for interventional radiologists to accurately diagnose and treat these complex lesions. At the end of this educational exhibit participants shall:
1. Understand the pathophysiology and classification of pelvic high-flow AVMs;

2. Recognize the clinical presentation and diagnostic challenges of pelvic high-flow AVMs;
3. Enhance their use of angiography and adjunctive imaging modalities in diagnosing pelvic high-flow AVMs and treatment planning; and,
4. Review interventional radiology techniques for the management of pelvic high-flow AVMs with an emphasis on clinical insights.

Background: Pelvic high-flow AVMs are rare, vascular anomalies characterized by abnormal arteriovenous shunting in the pelvis leading to increased blood flow and associated complications. These lesions are usually congenital but they may remain asymptomatic for several years, with symptoms often becoming apparent only in adulthood. Pelvic high-flow AVMs may involve the iliac arteries and veins, causing hemodynamic changes that lead to various symptoms, such as pelvic pain, vaginal bleeding, and varicosities. As the clinical presentation is nonspecific, pelvic high-flow AVMs are frequently misdiagnosed.

Clinical Findings/Procedure Details: We shall review practice tips to optimize the use of angiography to delineate arterial feeders, nidus, if present, and venous drainage patterns of pelvic high-flow AVMs and discuss the implications of identified vascular anatomy and flow dynamics on treatment planning. Various treatment approaches shall be highlighted, including transarterial, transvenous and direct percutaneous techniques as well as the role of adjunctive imaging modalities in treatment. We shall provide a case-based discussion outlining the importance of appropriate embolization agent selection to achieve durable occlusion and deep nidus penetration leading to tangible clinical outcomes.

Conclusion and/or Teaching Points: Drawing on the 20-year-experience of our high-volume, tertiary academic institution, key teaching points of this educational exhibit shall include:
1. Recognizing the diverse clinical presentations of pelvic high-flow AVMs;

2. Optimizing the use of angiography and adjunctive imaging modalities in diagnosing pelvic high-flow AVMs and treatment planning; and,

3. Understanding the nuances of embolization agent selection and associated techniques.