0:01

This is a companion case to our AVM.

0:04

In this particular case, we only

0:05

needed to do transabdominal.

0:06

We have a bladder full.

0:07

We could see our uterus pretty well.

0:09

And you can see there's a lot of

0:10

heterogeneity up towards the fundus,

0:12

and a lot of color Doppler flow.

0:15

We put a lot of different spectral Dopplers on

0:17

her to try and figure out what was going on.

0:19

This waveform's a bit of a high resistance.

0:21

We got up to 67 centimeters per second.

0:24

As we kept going trying to find these, our

0:26

peak velocities kept getting higher and higher.

0:29

And she was someone who had suffered a

0:30

miscarriage and had continual bleeding

0:32

afterwards and had transvaginal imaging

0:34

showing what looked like an AVM.

0:36

So prior to going to CVIR, we again tried

0:38

to get these peaks to stop velocities to

0:40

see if she would benefit from conservative

0:44

therapy, just watching and waiting.

0:46

But since her velocities were up to the

0:47

200th, we felt that this would not and that

0:49

she was a good candidate for intervention.

0:52

This was actually used, what

0:53

we did here, was a B mode.

0:55

This is not a contrast ultrasound,

0:57

but it does provide pretty neat

0:58

vascular images without contrast.

1:00

And in this particular case, what we

1:02

thought it helped was that our, our

1:04

velocities we were getting early on,

1:06

you couldn't angle correct necessarily.

1:08

We were just sort of guessing.

1:10

You know, there's so much color

1:11

Doppler flow, it's hard to tell exactly

1:13

which way we should put that box.

1:16

But when we did the B flow images, you

1:18

could get a better idea of which way

1:20

that vessel was flowing, so we could

1:22

angle correct a little bit better.

1:23

And that's when we started getting

1:24

these much higher vascular flows,

1:26

which we felt better represented what

1:27

was actually going on in her case.

1:30

Here's a pre-procedural planning CTA.

1:33

And again, just to show you how vascular

1:36

it is, and it's all sort of in the fundus

1:38

and a little bit anterior right here.

1:39

That's what she looked like there.

1:41

All those tangles of vessels.

1:43

Right there.

1:44

And then finally, she went to angio and you

1:48

can again see here this tangle of blood vessels.

1:51

To go back to the beginning of that feels very

1:53

early, but there's a larger kind of cystic

1:57

AVM itself, that larger nidus of the AVM here.

2:00

So she was embolized and did quite well

2:03

after this as well. Her AVM also got much

2:06

smaller in size and all of her velocities

2:08

went down to more normal levels as well.