Giulio, 17 years old, for over 7 years has discovered that he has an arteriovenous malformation (AVM) of the gluteal region. In his case this condition prevented him to sit for no more than a few minutes, to sleep well, to practice sports because of the constant pain. Usually benign vascular malformations are not painful, but sometimes it happens, and in some cases the pain can become disabling.

After several treatments at another center, with a surgical attempt that did not lead to positive results as the malformation has returned to present, Giulio and his family have turned to the IRCCS Rizzoli Orthopaedic Institute in Bologna. Here have been made over time various embolization treatments, interventional radiology interventions during which select and occlude certain blood vessels, which have relieved the pain without solving the symptoms completely, that kept showing up at intervals.

In July 2023, thanks to the new angio-suite present at Rizzoli for a few months, it was possible to carry out a unique combined treatment. "We decided to perform an embolization and electrosclerotherapy in a single session, a choice that would not have been possible without an angio-suite that combines in the same room of interventional radiology angiograph, CT and ultrasound - explains Dr. Giancarlo Facchini, interventional radiologist at the Institute’s Interventional Radiology. - Having noticed an improvement, but not in the long term, of Giulio’s condition after only embolization treatments, we decided to act also on the venous part and not only arterial, therefore also performing electrosclerotherapy, experimental technique with which the first patients were treated". 

A luglio 2023, grazie alla nuova angio-suite presente al Rizzoli da pochi mesi, è stato possibile svolgere un trattamento combinato unico nel suo genere. “Abbiamo deciso di eseguire un’embolizzazione e un’elettroscleroterapia in un’unica seduta, scelta che non sarebbe stata percorribile senza un’angio-suite che unisce nella stessa sala di radiologia interventistica angiografo, TC ed ecografo – spiega il dottor Giancarlo Facchini, radiologo interventista presso la Radiologia interventistica dell’Istituto. – Avendo notato sì un miglioramento, ma non a lungo termine, della condizione di Giulio dopo trattamenti di sola embolizzazione, abbiamo deciso di agire anche sulla parte venosa e non solo arteriosa, eseguendo quindi anche un’elettroscleroterapia, tecnica sperimentale con la quale sono stati trattati i primi pazienti”.

Electrosclerotherapy is a technique in which a sclerosing medication is injected into the malformation. Subsequently targeted electrical discharges then generate an electric field that allows better absorption of the drug by the cells of the malformation.

"This unique combination of treatments has led to a marked improvement in Giulio’s condition. He has resumed playing sports, sleeping well, to lead an active life and perfectly in line with his young age - stresses the director of diagnostic and interventional radiology of Rizzoli Dr. Marco Miceli. - Now we are in the follow-up phase to understand the effectiveness of this combo of long-term treatments, we can already say with certainty that to date it has proved to be the best solution".

"Being able to apply innovative treatments thanks to the latest technology available is stimulating - says Anselmo Campagna, general manager of Rizzoli. - Embolization and electrosclerotherapy in a single access would have been an impossible practice without our angio-suite. Thanks to angiograph, CT and ultrasound in a single room and highly specialized staff, Rizzoli has been able to offer the patient an innovative treatment in a simple Day Hospital hospitalization. Our hope and our goal is to be able to continue to identify the best cure for each of our patients, also thanks to the continuous research that is done in an IRCCS, Institute of Hospitalization and Scientific Care, such as Rizzoli".

Musculoskeletal interventional radiology deals with the diagnosis and treatment of musculoskeletal diseases using minimally invasive procedures performed under the guidance of images: ultrasound, angiography, computed tomography (CT).

Rizzoli’s angiosuite, acquired thanks to an investment of 2 million euros, is equipped with a digital angiograph for the definition of diagnostic questions of endovascular nature and for the execution of percutaneous and endovascular interventions, a CT (Computed Tomography) 128 layers, with double energy, useful to define the diagnostic question and to guide with extreme precision the operator during the therapeutic or palliative intervention, and an ultrasound for the localization of the most superficial anatomical structures. This hybrid system guarantees greater precision in the treatment of the patient and allows to speed up the path of diagnosis and treatment, with the possibility of less exposure to ionizing radiation, through the combined and optimized use of different techniques.