PMC7264987_01
The first MRI of the lesion.
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Otherwise, the pelvic structures were within normal limits (Fig. 1).
The sacro-gluteal mass at its largest size measuring 15*15*2 cm.
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Haemoglobin (Hb) reached as low as (5 g/dl) and the mass reached (15*15*2 cm) in size (Fig. 2).
First DSA showing the right internal iliac artery (above) pre-embolisation (on the left) and post-embolisation (on the right), left internal iliac artery pre-embolisation (middle two photos, median (middle) sacral artery pre-embolisation (lower left), and left internal iliac artery with median (middle) sacral artery post-embolisation (lower right).
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Selective embolization was conducted by injecting polyvinyl alcohol (PVA) particles (Fig. 3).
The AVM lesion after the embolization and surgery during the healing process.
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After 24 h excisional surgery was performed through an elliptical incision and the lesion was removed successfully with no complication (Fig. 4).
Post-operative MRI showing the remnant small nidus of the lesion.
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Post-operative MRI was conducted and showed a remnant of small nidus (Fig. 5) which was managed again by repeating selective embolization under general anaesthesia of the collateral artery of the left internal iliac artery and the median (middle) sacral artery was completely bolted (Fig. 6).
Final image of the lesion.
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No bleeding was noticed during the following dressing and the lesion was left to heal by second intention as counseling from the plastic and reconstructive surgery department saw this more adequate for this case (Fig. 7).