1
|
Matsumoto MM, Caridi TM. Uterine Vascular Anomalies: Management and Treatment Overview. Semin Intervent Radiol 2023; 40:342-348. [PMID: 37575348 PMCID: PMC10415054 DOI: 10.1055/s-0043-1770714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Uterine vascular anomalies (UVAs), while rare, can result in severe, life-threatening hemorrhage. An understanding of the presentation and management options for UVAs is important for interventional radiologists to appropriately evaluate and care for these patients. The authors propose a standardized terminology for UVAs to avoid confusion and conflating congenital from acquired vascular lesions, which have a different pathophysiology. Limited high-level evidence and no definitive guidelines for UVA management exist, although endovascular treatment with uterine artery embolization has generally become the first-line approach for symptomatic or persistent UVAs with high technical and clinical success rates. There is also no consensus on the optimal embolization technique; the authors propose an initial approach to first embolize the dominant uterine artery supplying the UVA with gelatin sponge, with the option to embolize the contralateral side at the time of initial embolization if there is persistent supply (avoiding bilateral empiric embolization). Repeat embolization is feasible and recommended in the setting of recurrence, and both clinical and imaging follow-up is important. Ultimately, a multidisciplinary approach with individualized patient management is needed, particularly in the face of a lack of consensus guidelines for the management of symptomatic UVAs.
Collapse
Affiliation(s)
- Monica M. Matsumoto
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa M. Caridi
- Department of Radiology, University of Alabama-Birmingham, Birmingham, Alabama
| |
Collapse
|
2
|
Ghanaati H, Firouznia K, Moradi B, Behestani S. Fertility Outcomes After Uterine Artery Embolization for Symptomatic Uterine Arteriovenous Malformations: A Single-Center Retrospective Study in 33 Women. Cardiovasc Intervent Radiol 2022; 45:983-991. [PMID: 35296933 DOI: 10.1007/s00270-022-03105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/21/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To describe the clinical and fertility outcomes after uterine artery embolization (UAE) for symptomatic uterine arteriovenous malformations (AVMs). MATERIALS AND METHODS This single-center retrospective study included 33 patients with uterine AVMs who underwent UAE at our institution between May 2013 and May 2021. The inclusion criteria were diagnostic features of uterine AVM as detection of the nidus and early venous drainage on angiography. The exclusion criteria were high levels of beta-human chorionic gonadotropin indicative of gestational trophoblastic neoplasia. Polyvinyl alcohol (PVA) with a diameter of 500-700 µm (with or without Gelfoam/Glue) was used in 32 procedures and, Glue (with lipiodol) was used in one. The patients were followed up for 31 months (range, 6-90 months). Angiograms, medical records, and phone interviews were used to describe the technical and clinical success, complications, and pregnancy outcomes. RESULTS Thirty-three patients with a mean age of 31.2 ± 5.4 years (range, 21-42 years) were included in this case series. Technical success was reported in all patients (100%). Bleeding control was also achieved in 32 (96%) patients. Pelvic and puncture site pain and groin hematoma were reported as minor complications (grade 1 according to CIRSE classification). Six pregnancies (33%) occurred after uterine artery embolization. Four women had full-term pregnancies without complications and delivered healthy newborns. Another two women were in the second trimester of pregnancy with a favorable fetal condition. No post-embolization miscarriage was reported. CONCLUSION The UAE is safe and effective in controlling vaginal bleeding caused by uterine AVMs, allowing successful future pregnancies.
Collapse
Affiliation(s)
- Hossein Ghanaati
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Kavous Firouznia
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Moradi
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Selda Behestani
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
3
|
Sharpless KE, Pappas II, Dobrow EM, Moccia M, Bates A, Pinette MG, Paul M. Severe hemorrhage due to acquired uterine arteriovenous malformation/fistula following first-trimester aspiration abortion: A case report. Case Rep Womens Health 2022; 34:e00410. [PMID: 35479418 PMCID: PMC9035398 DOI: 10.1016/j.crwh.2022.e00410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Uterine arteriovenous malformation/arteriovenous fistula is a rare, but potentially life-threatening, cause of severe hemorrhage. A case of uterine arteriovenous malformation/fistula causing severe hemorrhage following a first-trimester aspiration abortion procedure in a patient with a history of prior cesarean sections is presented. In this case, the patient was promptly diagnosed and effectively treated with uterine artery embolization. Consideration of uterine arteriovenous malformation/fistula in the differential diagnosis of severe hemorrhage following first-trimester aspiration abortion, especially in women with risk factors, can lead to timely recognition and appropriate treatment. Uterine arteriovenous malformation/arteriovenous fistula is a vascular anomaly that can cause life-threatening hemorrhage. Acquired uterine arteriovenous malformation/arteriovenous fistula is a rare cause of hemorrhage following aspiration abortion. The diagnosis should be considered when hemorrhage fails to resolve with additional suction curettage and uterotonic administration. Uterine artery embolization is the treatment of choice for hemodynamically stable patients who want to preserve fertility.
Collapse
Affiliation(s)
- Kathryn E. Sharpless
- Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA
- Planned Parenthood of Northern New England, 443 Congress St., Portland, ME 04101, USA
- Corresponding author at: Department of Obstetrics and Gynecology, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA.
| | - India I. Pappas
- Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA
| | - Ethan M. Dobrow
- Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA
- VA Maine Healthcare System, 1 VA Ctr., Augusta, ME 04330, USA
| | - Matthew Moccia
- Maine Medical Center, 22 Bramhall St, Portland, ME 04102, USA
| | - Alison Bates
- Planned Parenthood of Northern New England, 443 Congress St., Portland, ME 04101, USA
| | | | - Maureen Paul
- Planned Parenthood of Northern New England, 443 Congress St., Portland, ME 04101, USA
- Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
| |
Collapse
|
4
|
Khera PS, Garg PK, Yadav T, Tiwari S, Ghosh TS, Sureka B, Rajagopal R. Emergency Uterine Bleeding: A Pictorial Essay of Imaging and Endovascular Management. Curr Probl Diagn Radiol 2022; 51:858-867. [DOI: 10.1067/j.cpradiol.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/16/2022] [Accepted: 04/18/2022] [Indexed: 11/22/2022]
|
5
|
Jha S, Singh A. Arteriovenous Malformation Complicating Cesarean Scar Pregnancy: A Rare Case of Vaginal Bleeding Managed Successfully by Uterine Artery Embolization. J Family Reprod Health 2021; 15:210-214. [PMID: 34721613 PMCID: PMC8536824 DOI: 10.18502/jfrh.v15i3.7140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Arteriovenous malformation (AVM) can occur in cesarean scar ectopic pregnancy. The presence of retained product of conception can pose a diagnostic dilemma and clinical presentation could be similar. Case report: A 27 year old female presented with continuous vaginal bleeding for two and half months following dilatation and evacuation (D&E) done for cesarean scar pregnancy (CSP) of 10 weeks 4days period of gestation. Sonography with color Doppler revealed dilated tortuous vessels around the mass in lower uterine segment suggesting CSP with AVM. Digital subtraction angiography confirmed the diagnosis. Bilateral uterine artery embolization achieved complete devascularisation as confirmed on post intervention angiogram. Patient became symptom free since then. Conclusion: Uterine artery embolization is an effective mode of treatment of AVM complicating CSP if future fertility is desired.
Collapse
Affiliation(s)
- Sangam Jha
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Bihar, India
| | - Akanksha Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Bihar, India
| |
Collapse
|
6
|
Moynihan HV, Richardson J, Loveridge K. Fertility-Preserving Management of Uterine Arteriovenous Malformation in a 16-Year-Old Female. Cureus 2021; 13:e18162. [PMID: 34584814 PMCID: PMC8457299 DOI: 10.7759/cureus.18162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
Arteriovenous malformations (AVM) are abnormal connections between arteries and veins without a capillary bed, creating high- and low-flow areas that are prone to bleeding. Uterine AVMs can be congenital or acquired with an incidence of 0.1%. Acquired cases are usually caused by uterine instrumentation, trauma, infection, or gestational trophoblastic disease. Patients typically present with sudden onset of heavy vaginal bleeding. Diagnosis is made using angiography, ultrasound, computerized tomography, or magnetic resonance imaging. After patients are stabilized, management depends on their desire for future fertility and may include hysterectomy or endovascular embolization. We present the case of a 16-year-old G1P0010 female with recurrent vaginal bleeding caused by a uterine AVM. To preserve the patient’s fertility, a selective embolization approach was employed using microcoils and gel foam. This case highlights a unique treatment option for uterine AVMs in patients who desire fertility preservation. Additionally, we review the diagnostic imaging and treatment options for uterine AVMs.
Collapse
Affiliation(s)
| | - Jordan Richardson
- Emergency Medicine, Detroit Medical Center Children's Hospital of Michigan, Detroit, USA
| | | |
Collapse
|
7
|
Clinical Conundrum: A 39-Year-Old With Chronic Retained Products of Conception and Concurrent Uterine Arteriovenous Malformation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:864-868. [PMID: 34253305 DOI: 10.1016/j.jogc.2021.02.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 11/22/2022]
Abstract
A 39-year-old woman presented with bleeding 4 months after a surgical termination of pregnancy. Persistent beta-human chorionic gonadotropin levels were suggestive of retained products of conception (RPOC). However, multimodal imaging revealed a concurrent uterine arteriovenous malformation (AVM). Although most stable AVMs can be managed conservatively, the need for surgical management of chronic RPOC and consequential hemorrhage risk complicates this approach. Patient-determined management prioritized blood conservation while minimizing risks to fertility. This case is discussed with respect to the rare concurrent existence of RPOC and AVM. Little is known regarding the optimal tandem therapeutic approach. As depicted, successful treatment requires careful diagnostic workup and a multidisciplinary approach.
Collapse
|
8
|
Raisonnement clinique : Une femme de 39 ans atteinte de rétention chronique de produits de conception et d'une malformation artérioveineuse utérine concomitante. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:869-873. [PMID: 33862274 DOI: 10.1016/j.jogc.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
9
|
Oh CH, Kim Y, Cho BS, Yi KS. Successful transcatheter arterial embolization for massive hemorrhage from acquired uterine arteriovenous malformation which occurred as a complication of hysterectomy: A case report. Medicine (Baltimore) 2021; 100:e24052. [PMID: 33466159 PMCID: PMC7808482 DOI: 10.1097/md.0000000000024052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Uterine arteriovenous malformation (UVM), which can be congenital or acquired, is a relatively rare disorder that can cause life-threatening hemorrhage. Acquired UVM occurs predominantly after previous uterine procedures; rarely, it may occur after a hysterectomy. Although the best treatment option for UVM remains controversial, transcatheter arterial embolization (TAE) has recently been introduced as a safe and effective treatment. PATIENT CONCERNS A 34-year-old woman who underwent hysterectomy for uncontrolled postpartum bleeding continued to have hemoperitoneum. DIAGNOSIS Two days after surgery, massive hemoperitoneum was identified on computed tomography scan, and acquired UVM was diagnosed by angiography. INTERVENTIONS The patient was successfully treated using TAE with an n-Butyl cyanoacrylate. OUTCOMES After embolization, hemodynamic stability was achieved. A day after embolization, hemoglobin was 10.2 g/dL, and the patient was discharged from the hospital 4 days thereafter. LESSONS Although the overall incidence of acquired UVM after hysterectomy is low, bleeding from acquired UVM should be considered as one of the differential diagnoses in the immediate postpartum period, especially when the clinical symptoms do not correlate with the amount of blood loss. A high index of suspicion, prompt diagnosis and intervention, and a multidisciplinary approach in the management were the elements of a successful outcome in this case.
Collapse
Affiliation(s)
| | | | | | - Kyung Sik Yi
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| |
Collapse
|
10
|
Giurazza F, Corvino F, Silvestre M, Cavaglià E, Amodio F, Cangiano G, De Magistris G, Niola R. Uterine Arteriovenous Malformations. Semin Ultrasound CT MR 2020; 42:37-45. [PMID: 33541588 DOI: 10.1053/j.sult.2020.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Uterine arteriovenous malformations are rare but may represent a life-threatening cause of vaginal bleeding. The typical patient affected is a multiparous woman during her thirties. The origin can be congenital or acquired, with the latter being more common after uterine surgery and presenting mainly as arteriovenous fistulous connections into the myometrium supplied by uterine arteries. The correct diagnosis of uterine arteriovenous malformations requires imaging findings of tubular and tortuous structures with mixed signal from arterial and venous flows; transvaginal color-Doppler ultrasound is the initial technique applied, then integrated with contrast-enhanced magnetic resonance or computed tomography. Multiple treatment approaches are available, including conservative-medical, endovascular embolization and surgery. Transarterial embolization represents the most applied, preserving childbearing capacity with negligible procedural complications; clinical and technical success rates are elevated, up to 90%. The goal of embolization is to occlude the point of fistula or the nidus and the application of multiple embolizing agents has been reported: despite there is no clear superiority of one over the others, liquids, especially those related to the dymethil-sulfoxide family, present relevant technical advantages. Surgery is nowadays to be considered when the endovascular approach fails and in these cases hysterectomy remains the common recommendation.
Collapse
Affiliation(s)
- Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy.
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Mattia Silvestre
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Enrico Cavaglià
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Francesco Amodio
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Gianluca Cangiano
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Giuseppe De Magistris
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| |
Collapse
|
11
|
Lollie TK, Raman SS, Qorbani A, Farzaneh T, Moatamed NA. Rare occurrence of uterine arteriovenous malformation clinically mimicking a malignant growth: A critical reminder for pathologists. AUTOPSY AND CASE REPORTS 2020; 10:e2020144. [PMID: 33344290 PMCID: PMC7703198 DOI: 10.4322/acr.2020.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Arteriovenous malformation (AVM) is a rare lesion in the uterus, which can lead to abnormal uterine bleeding. While AVM has been described in other organs in the literature, there is a paucity of pathology reports of the AVM in uterus. On gross examination, the uterus was markedly enlarged and partly distorted with a pedunculated solid mass, which on the cut surface showed multiple well-circumscribed hemorrhagic cysts ranging from 0.1 to 4.0 cm in size. Microscopically, they were malformed dilated vascular structures containing organized thrombi. We present this case of uterine AVM with gross and microscopic findings, which can serve as a crucial reminder for pathologists to keep in the differential diagnoses as a potential cause of abnormal uterine bleeding.
Collapse
Affiliation(s)
- Trang K Lollie
- University of California (UCLA), David Geffen School of Medicine, Department of Pathology and Laboratory Medicine. Los Angeles, CA, USA
| | - Steven S Raman
- University of California (UCLA), David Geffen School of Medicine, Department of Radiological Sciences. Los Angeles, CA, USA
| | - Amir Qorbani
- University of California (UCLA), David Geffen School of Medicine, Department of Pathology and Laboratory Medicine. Los Angeles, CA, USA.,University of California San Francisco, School of Medicine, Department of Pathology and Laboratory Medicine. San Francisco, CA, USA
| | - Ted Farzaneh
- University of California (UCLA), David Geffen School of Medicine, Department of Pathology and Laboratory Medicine. Los Angeles, CA, USA.,University of California Irvine, School of Medicine, Department of Pathology and Laboratory Medicine. Irvine, CA, USA
| | - Neda A Moatamed
- University of California (UCLA), David Geffen School of Medicine, Department of Pathology and Laboratory Medicine. Los Angeles, CA, USA
| |
Collapse
|
12
|
Hong W, Wang BY, Wu ZP, Gao F, Li SD, Li XC. Systematic retrospective analysis of 13 cases of uterine arteriovenous fistula: Pathogeny, diagnosis, treatment and follow-up. J Obstet Gynaecol Res 2020; 46:1117-1127. [PMID: 32367675 DOI: 10.1111/jog.14264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/30/2020] [Accepted: 03/14/2020] [Indexed: 12/17/2022]
Abstract
AIM To analyze the causes, clinical manifestations, diagnosis and treatment of uterine arteriovenous fistula (UAVF). METHODS We retrospectively analyzed 13 patients with UAVF admitted to our hospital from October 2016 to April 2019. RESULTS All patients had a history of intrauterine surgery (curettage for abortion, artificial removal of placenta, hysteroscopy, diagnostic curettage and intrauterine device removal). The main clinical manifestation of UAVF is paroxysmal massive vaginal bleeding; this involved a massive gush of vaginal blood that stopped suddenly. Sonographic images with typical features of UAVF were observed for 12 patients. Pelvic contrast-enhanced magnetic resonance imaging was performed as a noninvasive adjuvant examination method for diagnosis. Twelve patients underwent uterine arteriography and a diagnosis of UAVF was confirmed. Then, bilateral uterine artery embolization (UAE) was performed. One patient underwent laparoscopic hysterectomy directly instead of uterine arteriography because of unstable vital signs and one patient underwent laparoscopic hysterectomy 25 weeks after the second UAE. The median time until menstrual recovery was 33 days (range, 20-70 days) after UAE. The median time until normal ultrasound examination results was 10 weeks (range, 2-35 weeks). CONCLUSION Acquired UAVF was associated with a history of previous intrauterine surgery. The ultrasound examination and pelvic contrast-enhanced MRI were noninvasive adjuvant examination method to effectively assist in diagnosis. Uterine arteriography is considered the gold standard for the diagnosis of UAVF, and UAE is considered an effective intervention for treating UAVF and maintaining reproductive function with less damage. Hysterectomy is an appropriate option when conservative measures have failed to prevent a life-threatening hemorrhage.
Collapse
Affiliation(s)
- Wei Hong
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bei-Ying Wang
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhi-Ping Wu
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feng Gao
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuang-Di Li
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Cui Li
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
13
|
Kurda D, Guduguntla G, Maingard J, Kok HK, Lalloo S. Precipitating hydrophobic injectable liquid (PHIL) embolic for the treatment of a uterine arteriovenous malformation: a technical report. CVIR Endovasc 2019; 2:17. [PMID: 32026176 PMCID: PMC7224241 DOI: 10.1186/s42155-019-0059-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Uterine arteriovenous malformations (AVM) are unusual causes of vaginal bleeding. Although hysterectomy is the definitive treatment; uterine artery embolization (UAE) provides an alternative therapeutic option. This case presents a technical report of a uterine AVM treated successfully with transcatheter UAE using precipitating hydrophobic injectable liquid (PHIL) embolic agent. CASE REPORT A 41-year-old female, gravida 6, para 4, miscarriage 2, including a molar pregnancy 15 years prior, presented with massive per vaginal bleeding. Pelvic ultrasound demonstrated an acquired AVM as the underlying aetiology for her presentation. The patient underwent bilateral uterine arterial embolization. Four weeks later, there was nearly complete resolution of the AVM and the patient's menstrual cycle was restored 8 weeks after the procedure. CONCLUSION Uterine AVM can be treated safely and effectively with UAE using PHIL.
Collapse
Affiliation(s)
- Dylan Kurda
- Interventional Radiology, The Canberra Hospital, Canberra, Australia.
| | - Geetha Guduguntla
- Interventional Radiology, The Canberra Hospital, Canberra, Australia
| | - Julian Maingard
- Interventional Radiology, Austin Health, Melbourne, VIC, Australia
- School of Medicine, Deakin University, Waurn Ponds, Geelong, Australia
| | - Hong Kuan Kok
- School of Medicine, Deakin University, Waurn Ponds, Geelong, Australia
- Interventional Radiology, Northern Health, Melbourne, VIC, Australia
| | - Shivendra Lalloo
- Interventional Radiology, The Canberra Hospital, Canberra, Australia
| |
Collapse
|
14
|
Delplanque S, Le Lous M, Proisy M, Joueidi Y, Bauville E, Rozel C, Beraud E, Bruneau B, Levêque J, Lavoué V, Nyangoh Timoh K. Fertility, Pregnancy, and Clinical Outcomes after Uterine Arteriovenous Malformation Management. J Minim Invasive Gynecol 2019; 26:153-161. [DOI: 10.1016/j.jmig.2018.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/14/2018] [Accepted: 05/02/2018] [Indexed: 02/07/2023]
|
15
|
Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate for the Treatment of Acquired Uterine Vascular Malformations. Cardiovasc Intervent Radiol 2016; 39:1170-6. [DOI: 10.1007/s00270-016-1328-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
|
16
|
Yoon DJ, Jones M, Taani JA, Buhimschi C, Dowell JD. A Systematic Review of Acquired Uterine Arteriovenous Malformations: Pathophysiology, Diagnosis, and Transcatheter Treatment. AJP Rep 2016; 6:e6-e14. [PMID: 26929872 PMCID: PMC4737639 DOI: 10.1055/s-0035-1563721] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/15/2015] [Indexed: 12/11/2022] Open
Abstract
Objective An acquired uterine arteriovenous malformation (AVM) is a rare cause of vaginal bleeding and, although hysterectomy is the definitive therapy, transcatheter embolization (TCE) provides an alternative treatment option. This systematic review presents the indications, technique, and outcomes for transcatheter treatment of the acquired uterine AVMs. Study Design Literature databases were searched from 2003 to 2013 for eligible clinical studies, including the patient characteristics, procedural indication, results, complications, as well as descriptions on laterality and embolic agents utilized. Results A total of 40 studies were included comprising of 54 patients (average age of 33.4 years). TCE had a primary success rate with symptomatic control of 61% (31 patients) and secondary success rate of 91% after repeated embolization. When combined with medical therapy, symptom resolution was noted in 48 (85%) patients without more invasive surgical procedures. Conclusion Low-level evidence supports the role of TCE, including in the event of persistent bleeding following initial embolization, for the treatment of acquired uterine AVMs. The variety of embolic agents and laterality of approach delineate the importance of refining procedural protocols in the treatment of the acquired uterine AVM. Condensation A review on the management of patients with acquired uterine AVMs.
Collapse
Affiliation(s)
- Daniel J Yoon
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Megan Jones
- Department of Obstetrics and Gynecology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jamal Al Taani
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Catalin Buhimschi
- Department of Obstetrics and Gynecology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Joshua D Dowell
- Division of Interventional Radiology, Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| |
Collapse
|
17
|
Chen LK, Yang BL, Chen KC, Tsai YL. Successful Transarterial Embolization of Uterine Arteriovenous Malformation: Report of Three Cases. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e15358. [PMID: 27110329 PMCID: PMC4835739 DOI: 10.5812/iranjradiol.15358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 05/24/2014] [Accepted: 05/31/2014] [Indexed: 12/25/2022]
Abstract
Uterine arteriovenous malformations (AVMs) are relatively rare disorders that can cause life-threatening vaginal bleeding. We describe three childbearing-age females, who had abdominal pain and heavy vaginal bleeding, and were diagnosed as uterine AVM by color Doppler and angiography. The patients received successful superselective transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA). Three years after treatment, one of them was admitted to our hospital for vaginal delivery at 39 weeks of gestation, and the baby was healthy.
Collapse
Affiliation(s)
- Liang-Kuang Chen
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, National Taiwan University, Taipei, Taiwan
- Corresponding author: Liang-Kuang Chen, Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. Tel: +886-228332211, Fax: +886-228389359, E-mail:
| | - Bi-Li Yang
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Tzu Chi University, Taipei, Taiwan
| | - Kuo-Chang Chen
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Chung Shan Medical University, Taipei, Taiwan
| | - Yieh-Loong Tsai
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Kaohsiung Medical University, Taipei, Taiwan
| |
Collapse
|
18
|
An Unusual Uterine Cavity Phenomenon. J Minim Invasive Gynecol 2015; 22:1130-1. [PMID: 25678419 DOI: 10.1016/j.jmig.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/31/2015] [Accepted: 02/02/2015] [Indexed: 11/21/2022]
|
19
|
Patton EW, Moy I, Milad MP, Vogezang R. Fertility-preserving management of a uterine arteriovenous malformation: a case report of uterine artery embolization (UAE) followed by laparoscopic resection. J Minim Invasive Gynecol 2014; 22:137-41. [PMID: 25117839 DOI: 10.1016/j.jmig.2014.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/30/2014] [Accepted: 07/31/2014] [Indexed: 12/14/2022]
Abstract
Herein is presented a fertility-preserving approach in the management of a uterine arteriovenous malformation (AVM) resistant to endovascular management. The patient had a documented AVM and underwent 2 uterine artery embolization procedures, with subsequent recurrence of symptoms. Doppler ultrasound demonstrated recanalization of the AVM. Ultimately, laparoscopic resection of the AVM was performed after laparoscopic ligation of the uterine arteries. Postoperatively, the patient has remained asymptomatic. Laparoscopic resection of a uterine AVM may offer a fertility-preserving alternative to hysterectomy in patients in whom endovascular management has failed.
Collapse
Affiliation(s)
- Elizabeth W Patton
- Robert Wood Johnson Clinical Scholar Program, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, Michigan; Department of Women's Health/Reproductive Endocrinology, Kaiser Permanente, San Francisco, California; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Irene Moy
- Robert Wood Johnson Clinical Scholar Program, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, Michigan; Department of Women's Health/Reproductive Endocrinology, Kaiser Permanente, San Francisco, California; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Magdy P Milad
- Robert Wood Johnson Clinical Scholar Program, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, Michigan; Department of Women's Health/Reproductive Endocrinology, Kaiser Permanente, San Francisco, California; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert Vogezang
- Robert Wood Johnson Clinical Scholar Program, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, Michigan; Department of Women's Health/Reproductive Endocrinology, Kaiser Permanente, San Francisco, California; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Radiology, Section of Interventional Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
20
|
Lin CJ, Huang LW, Lin YH, Hwang JL, Seow KM. Interstitial ectopic pregnancy complicated by uterine arteriovenous malformations treated with unilateral transarterial embolization. Taiwan J Obstet Gynecol 2014; 53:279-81. [PMID: 25017288 DOI: 10.1016/j.tjog.2013.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 11/18/2022] Open
Affiliation(s)
- Chun-Ju Lin
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Lee-Wen Huang
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei Hsien, Taiwan
| | - Yu-Hung Lin
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei Hsien, Taiwan
| | - Jiann-Loung Hwang
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan.
| |
Collapse
|
21
|
Failed transarterial embolization of subserosal uterine arteriovenous malformation. Obstet Gynecol Sci 2013; 56:333-7. [PMID: 24328024 PMCID: PMC3784124 DOI: 10.5468/ogs.2013.56.5.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/17/2013] [Accepted: 04/23/2013] [Indexed: 01/18/2023] Open
Abstract
Uterine arteriovenous malformation (AVM) is rare but potentially life-threatening from excessive vaginal bleeding. All uterine AVMs reported to date have been found in the endometrial or myometrial layers. Here we present a patient with a subserosal type AVM on the fundus of uterus, which spontaneously ruptured.
Collapse
|
22
|
Hilal K, Masroor I, Aziz A, Sayani R. Acquired vascular malformation in ruptured caesarean section scar: a rare cause of life-threatening vaginal bleeding. BMJ Case Rep 2013; 2013:bcr2013009489. [PMID: 23839607 PMCID: PMC3736155 DOI: 10.1136/bcr-2013-009489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Uterine arteriovenous malformations (AVM) are rare and potentially life-threatening lesions. Patients present with severe vaginal bleeding which usually does not respond to conservative management and on most of occasions requires radiological or surgical intervention. We report a case of acquired AVM in a ruptured caesarean section scar. The patient presented with life-threatening vaginal bleeding and was treated with gonadotropin releasing hormone agonist and subsequent angioembolisation coiling.
Collapse
Affiliation(s)
- Kiran Hilal
- Department of Radiology, Aga Khan University Hospital, Karachi, Sindh, Pakistan.
| | | | | | | |
Collapse
|
23
|
Chen SQ, Jiang HY, Li JB, Fan L, Liu MJ, Yao SZ. Treatment of uterine arteriovenous malformation by myometrial lesion resection combined with artery occlusion under laparoscopy: a case report and literature review. Eur J Obstet Gynecol Reprod Biol 2013; 169:172-6. [DOI: 10.1016/j.ejogrb.2013.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 03/23/2013] [Accepted: 04/24/2013] [Indexed: 02/03/2023]
|
24
|
Amso NN, Shayeb AG. Intraoperative imaging. Best Pract Res Clin Obstet Gynaecol 2013; 27:323-38. [PMID: 23587767 DOI: 10.1016/j.bpobgyn.2013.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/20/2013] [Indexed: 11/24/2022]
Abstract
Intraoperative image is a rapidly expanding field encompassing many applications that use a multitude of technologies. Some of the these applications have been in use for many years and are firmly embedded in, and indispensable to, clinical practice (e.g. the use of X-ray to locate foreign bodies during surgery or oocyte retrieval under ultrasound guidance. In others, the application may have been in use in one discipline but not yet fully explored in another. Examples include the use of intraoperative ultrasound with or without contrast enhancement for the detection of hepatic metastases not identified preoperatively, and the effect of such additional information on the ultimate operative procedure. Intraoperative identification of sentinel lymph nodes has been explored in many specialties to a varying extent, with the aim of fine tuning and avoiding unnecessary surgery. In both these instances, we do not know the long-term effect of these interventions on patient survival or quality of life. In this chapter, we will explore the available evidence on these applications and current advances in the new technology in general, with a specific focus on gynaecology.
Collapse
Affiliation(s)
- Nazar N Amso
- Cardiff University, School of Medicine, Heath Park, Cardiff CF14 4XW, UK.
| | | |
Collapse
|
25
|
Rosen RJ, Nassiri N, Drury JE. Interventional Management of High-Flow Vascular Malformations. Tech Vasc Interv Radiol 2013; 16:22-38. [DOI: 10.1053/j.tvir.2013.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
26
|
Clarke JA, Viswanatha RK, Hamid R, Sankaranarayanan S. Diagnosis and management of life-threatening hypermenorrhagia caused by uterine arteriovenous malformation secondary to surgical termination of pregnancy: video evidence! BMJ Case Rep 2012; 2012:bcr-2012-007368. [PMID: 23213129 DOI: 10.1136/bcr-2012-007368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 23-year-old lady presented with a 10-month history of multiple episodes of prolonged and erratic menstrual bleeding having undergone a surgical termination of pregnancy. Initially, pelvic ultrasound and hysteroscopy were found to be normal and for many months she was treated pharmacologically for dysfunctional uterine bleeding. She also tried both a copper-coil and MIRENA intrauterine system, which were both expelled due to heavy bleeding characterised by 'a clot the size of two fists'. She required blood transfusions on multiple admissions, was forced to resign from her job and later became depressed. Under our care a transvaginal ultrasound scan showed a hypervascular region on the posterior uterine wall. An urgent hysteroscopy was performed due to her haemoglobin being 5.7 g/dl and revealed a pulsating lesion abutting the endometrium, which can be seen here on video. MR angiography confirmed an arteriovenous malformation and she was successfully treated with uterine artery embolisation.
Collapse
|
27
|
Hasegawa A, Sasaki H, Wada-Hiraike O, Osuga Y, Yano T, Usman SM, Akahane M, Kozuma S, Taketani Y. Uterine Arteriovenous Fistula Treated With Repetitive Transcatheter Embolization: Case Report. J Minim Invasive Gynecol 2012; 19:780-4. [DOI: 10.1016/j.jmig.2012.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 07/09/2012] [Accepted: 07/12/2012] [Indexed: 10/27/2022]
|