Treating a recurrent uterine arteriovenous malformation with uterine artery embolization. A case report.
ABSTRACT Uterine arteriovenous malformation is a rare condition. Uterine artery embolization offers the possibility of conservative management as opposed to the traditional hysterectomy. We report a case with recurrent uterine arteriovenous malformation confirmed by angiography and successfully treated with a second embolization procedure.
A 33-year-old woman presented with heavy vaginal bleeding. The diagnosis of uterine arteriovenous malformation was suspected on Doppler ultrasonography and confirmed by angiography. The first embolization procedure was performed using polyvinyl alcohol and steel coils. Recurrence was diagnosed 1 year later with the same imaging techniques. The second embolization procedure was performed using histoacryl. The patient remained asymptomatic at 1-year of follow-up.
Minimally invasive management is an option in recurrent uterine arteriovenous malformation.
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ABSTRACT: To describe the outcome of patients with uterine arteriovenous malformations (AVMs) after uterine artery embolization (UAE). Retrospective case series. Tertiary center of a university hospital. Thirteen patients were referred to a tertiary medical center from primary care facilities with profuse uterine bleeding. Uterine artery embolization. Thirteen patients underwent UAE. Eleven patients had no additional vaginal bleeding, whereas two patients underwent hysterectomy after embolization. Twelve patients developed AVMs after induced abortions. One patient had a congenital uterine AVM. Based on the transfer notes, eight cases had incomplete abortions, three cases had dysfunctional uterine bleeding, one case had a molar pregnancy, and one case had a uterine AVM. Two cases underwent hysterectomy after UAE. One patient delivered a healthy baby after bilateral UAE. Uterine AVMs should be suspected in patients with abrupt, profuse vaginal bleeding and a medical history of an induced abortion. Primary physicians should consider uterine AVMs with such a medical history. A prompt diagnosis and therapy are essential for favorable outcomes in patients with uterine AVMs.Fertility and sterility 11/2010; 94(6):2330.e7-10. · 3.97 Impact Factor
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ABSTRACT: A 19-year-old patient presented with intractable uterine bleeding, 11weeks post-abortion. A pelvic ultrasound with Doppler and color imaging suggested a uterine arteriovenous malformation. Failing conservative therapies, the patient consented to uterine artery embolization (UAE). Two months later, she conceived and had an uneventful normal vaginal delivery at term. Since this is an extremely rare condition, allowing limited clinical exposure and experience, there may be an underlying reluctance by general practitioners to treat these cases with uterine artery embolization for fear of compromising future fertility and pregnancies. However, data from the 20 pregnancies embolized for uterine AVM cited in the present report and data from embolization for uterine fibroids indicate that such fears may be unfounded since pregnancy rates and outcomes may not be compromised after UAE. KeywordsMenorrhagia-Arteriovenous malformation-Uterine artery embolization-PregnancyGynecological Surgery 01/2010; 7(4):401-405.
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ABSTRACT: To perform an extensive systematic review to examine all the available literature reporting iatrogenic acquired arteriovenous malformation (AVM) induced after diagnostic curettage and to describe a further case of a 34-year-old woman presenting with acute vaginal bleeding due to AVM induced after uterine curettage for termination of pregnancy. We searched the electronic databases: MEDLINE (1950-2011), Embase (1980-2011), Cochrane Library (2004-2011), Cinahl (1981-2011), Popline (2004-2011). Initial search extracted 333 relevant articles. Final assessment resulted to the inclusion of 91 studies, 85 case reports and 6 observational studies. Studies are dated between 1954 and 2011. A metanalysis of the 85 case reports reporting 100 patients was performed. The mean age of the women diagnosed with AVM was 30 ± 9.1 years, range (16-72) years, 96 women were premenopausal (96%) and 4 were postmenopausal (4%). Ultrasound imaging was applied in 86 patients (86%), and ultrasound combined with angiography was performed in 51 patients (51%). Uterine artery embolization (UAE) was the most common treatment option performed in 59 patients (59%). Total abdominal hysterectomy was performed in 29 patients (29%). Spontaneous resolution of AVM occurred in six patients (6%). In 17 patients (17%), recurrence occurred after treatment with UAE. Twenty-four articles reported pregnancies in 27 patients (27%). Ultrasound imaging with appropriate knowledge of color Doppler features minimizes the use of inappropriate interventional procedures such as diagnostic curettage. UAE is effective in treatment, and rarely leads to complications.Archives of Gynecology 09/2011; 284(5):1137-51. · 0.91 Impact Factor