Endovascular embolo-sclerotherapy using absolute ethanol for pelvic arteriovenous malformations: Initial experience at the University Medical Center Ho Chi Minh City

Background: Pelvic arteriovenous malformations (pAVMs) are rare, complex lesions that are challenging to treat surgically. Endovascular embolo-sclerotherapy with absolute alcohol has emerged as a promising, less invasive treatment modality. Objective: To evaluate the clinical and imaging outcomes of endovascular absolute ethanol embolo-sclerotherapy in patients with pelvic arteriovenous malformations. Method: This retrospective case series included six patients (5 males, 1 female; mean age 49 ± 11 years) diagnosed with pAVMs and treated with ethanol embolo-sclerotherapy at our institution from October 2022 to October 2025. All procedures were performed under general anesthesia via transarterial access. Absolute ethanol (99.9%) was used as the primary sclerosant, with adjunctive N-butyl cyanoacrylate (NBCA) in one case. Patients were evaluated clinically and radiologically immediately after treatment and during follow-up at 1, 6, and 12 months. Result: A total of 13 embolo-sclerotherapy sessions were performed (range: 1–5 per patient; mean: 2.2). Complete angiographic obliteration was achieved in 5 patients (83.3%). Clinical improvement, including reduction in pelvic pain, pelvic fullness, and pelvic pain associated with sexual activity, was observed in 5 patients. One patient demonstrated partial improvement and required additional staged treatment. No major complications such as bladder or uterine necrosis occurred; minor transient pelvic discomfort and hemoglobinuria were managed conservatively. Conclusion: Endovascular ethanol embolo-sclerotherapy is an effective and safe treatment option for pelvic AVMs, demonstrating high rates of clinical and angiographic success with manageable complications.