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Chawla S, Sharma R. Retained Products of Conception (RPOC): Diagnosis, Complication & Management. J Obstet Gynaecol India 2023; 73:374-380. [PMID: 37916054 PMCID: PMC10616057 DOI: 10.1007/s13224-023-01873-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Retained products of conception (RPOC) generally result after first half of pregnancy termination and also may occur after vaginal or cesarean delivery. It frequently presents with irregular or continuous vaginal bleeding, lower abdominal and pelvic pain, and discharge per vaginum due to infection; it can also cause late complications like formation of intrauterine adhesions and subfertility. The diagnosis of the RPOC along with the symptoms is generally supported by ultrasonography with or without colour Doppler. The patient also undergoes uterine vasculature assessment to diagnose arteriovenous malformation (AVM). The management of RPOC has been conventionally done with blind dilation and suction curettage (D and C); however, expectant management, uterine artery embolization, and hysteroscopic resection of RPOC are safe and efficient alternatives. Materials and methods In this review, we analyse the current available evidence regarding the clinical presentation, diagnosis and treatment of RPOC comparing the sensitivity, specificity, outcomes, pros and cons of various methods. Conclusion RPOC is a common complication associated with early and late complications. The judicious use of antibiotics along with interventional radiology and hysteroscopy forms the backbone for the treatment of this condition.
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Xie Z, Wang Y, Chen R. Persistent cornual pregnancy mimicking uterine arteriovenous malformation: a case report. BMC Womens Health 2023; 23:314. [PMID: 37328873 PMCID: PMC10276523 DOI: 10.1186/s12905-023-02450-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/24/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Uterine arteriovenous malformation(AVM) refers to the abnormal direct traffic between uterine arteries and veins, which can be characterized by the imaging examination, showing increased uterine vascularity and arteriovenous shunting. However, similar imaging manifestations can also be seen in a variety of conditions including retained production of conception, gestational trophoblastic disease, placental polyp, and vascular neoplasm. CASE PRESENTATION Here we present a case of a 42-year-old woman who was suspected of suffering uterine AVM indicated by Doppler sonography and magnetic resonance imaging but was finally diagnosed with a persistent ectopic pregnancy located on the right uterine corner by pathology after laparoscopy. She recovered well after surgery. CONCLUSION Uterine AVM is a rare and serious condition. In general, it presents special radiological manifestations. However, when complicated with other diseases it can also be distorting. Standardized diagnosis and management are important.
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Affiliation(s)
- Zhuolin Xie
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Rong Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, National Clinical Research Center for Obstetric & Gynecologic Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
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3
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Yammine K, Osman D, Daher J, Salha M, Mouawad S. Acquired uterine arteriovenous malformation treated with superselective embolization: Case report. Radiol Case Rep 2023; 18:2204-2208. [PMID: 37101894 PMCID: PMC10123316 DOI: 10.1016/j.radcr.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 04/28/2023] Open
Abstract
Acquired uterine arteriovenous malformation is a rare condition, sometimes provoking abnormal life-threatening uterine hemorrhage. Here, we present the case of a 30-year-old healthy woman who developed heavy vaginal bleeding after dilatation and suctioning of the placenta 1 month after the delivery of a nonviable fetus. An ultrasound was performed which showed the appearance of a large exacerbation of a vessel with positive fetal sounds, normal cardiac movement, and normal morphological analysis. The patient was successfully treated with unilateral superselective embolization, distal to the ovarian supply, maintaining normal supply to the uterus and ovaries restoring normal menstruation, and showed complete resolution of the arteriovenous malformation.
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Affiliation(s)
- Kabalane Yammine
- Department of Diagnostic and interventional radiology, Clemenceau Medical Center, Beirut, Lebanon
- Corresponding author.
| | - Dani Osman
- Department of Surgery, University of LAU, Beirut, Lebanon
| | - Jihad Daher
- Department of Radiology, Clemenceau Medical Center, Beirut, Lebanon
| | - Makram Salha
- Department of Radiology, University of Balamand, Beirut, Lebanon
| | - Sabine Mouawad
- Department of Radiology, University of Balamand, Beirut, Lebanon
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Lu TF, Shih YH, Lu CH, Sun L. A new fertility-preserving treatment modality for life-threatening bleeding caused by acquired uterine arteriovenous malformation (AVM): Combination laparoscopic ligation of uterine arteries and AVM suture. Taiwan J Obstet Gynecol 2022; 61:703-707. [PMID: 35779926 DOI: 10.1016/j.tjog.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Symptomatic Uterine arteriovenous malformation (AVM) can result in sudden and massive vaginal bleeding that can be life-threatening. We report a new fertility-preserving treatment modality for disastrous bleeding caused by acquired uterine AVM: Combination laparoscopic ligation of uterine arteries and AVM suture. CASE REPORT A 39-year-old female received Dilatation and Curettage due to missed abortion. However, she experienced heavy vaginal bleeding after surgery. Uterine arteriovenous malformation (AVM) was diagnosed by color Doppler ultrasonography, hysteroscopy, and angiography. She was successfully treated using laparoscopy bilateral uterine arteries ligation followed by application of uterine AVM suture with absorbable barbed wound closure device. After the laparoscopic surgery, vaginal bleeding stopped immediately. Complete regression of the AVM lesion on sonography was noted 8 months after laparoscopic surgery. Besides, this patient had normal menstruation after the operation. CONCLUSION This case report describes for the first time a successful combination of bilateral uterine artery ligation and AVM suture to treat a patient with uterine arteriovenous malformation. We demonstrated the efficacy and safety of this fertility preserving method.
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Affiliation(s)
- Ting-Fang Lu
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yu-Hsiang Shih
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chien-Hsing Lu
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Biomedical Sciences, Program in Translational Medicine, and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan, ROC
| | - Lou Sun
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
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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. [PMID: 35296933 DOI: 10.1007/s00270-022-03105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [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.
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6
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Morita R, Abo D, Kinota N, Soyama T, Takahashi B, Yoshino Y, Tsuneta S, Kudo K. Successful transvenous embbolization for type II uterine arteriovenous malformation: A case report. Radiol Case Rep 2021; 16:2007-2011. [PMID: 34158882 PMCID: PMC8203566 DOI: 10.1016/j.radcr.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 12/01/2022] Open
Abstract
A 40-year-old female (gravida 3 para 1) presented with menstrual, urinary, and anal pain. Computed tomography revealed type II acquired uterine arteriovenous malformation, a common dilated venous sac with bilateral uterine arteries, and multiple branches of iliac arteries draining to the bilateral ovarian veins. Venous sac transvenous embolization via the left ovarian vein of dominant outflow was planned, since complete arteriovenous malformation occlusion was difficult with super-selective transarterial embolization of multiple feeders. Therefore, transarterial embolization of the minor feeder was performed before completing transvenous embolization using coils and 50% glue under left iliac artery flow control. Immediately thereafter, angiography confirmed the complete disappearance of the uterine arteriovenous malformation, and all pain symptoms remitted. In conclusion, transvenous embolization combined with adjunctive transarterial embolization can be an effective and radical treatment for type II uterine arteriovenous malformations.
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Affiliation(s)
- Ryo Morita
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan.,Department of Diagnostic Imaging, Faculty of Medicine, Hokkaido University, Kita 8, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-0838, Japan
| | - Daisuke Abo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Naoya Kinota
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Takeshi Soyama
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Bunya Takahashi
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Yuki Yoshino
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Faculty of Medicine, Hokkaido University, Kita 8, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-0838, Japan.,Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Kita 8, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-0848, Japan
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7
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Abstract
Incidental adnexal masses and uterine findings occur with a high frequency on cross-sectional imaging examinations, particularly in postmenopausal women in whom imaging is performed for a different reason. These incidentalomas encompass a gamut of potential pelvic gynecologic disorders. Most are benign ovarian cysts; however, other less commonly encountered disorders and improperly positioned gynecologic devices may be seen. A knowledge of the management recommendations for such pelvic incidental findings is critical to avoid unnecessary imaging and surgical interventions, as well as to avoid failure in diagnosis and management of some of these conditions.
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Affiliation(s)
- Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Abdominal Imaging and Emergency Radiology, Yale School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT 06520, USA.
| | - Anne Sailer
- Department of Radiology and Biomedical Imaging, Abdominal Imaging and Emergency Radiology, Yale School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT 06520, USA
| | - Mariam Moshiri
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195, USA
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8
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Vyas S, Choi HH, Whetstone S, Jha P, Poder L, Shum DJ. Ultrasound features help identify patients who can undergo noninvasive management for suspected retained products of conception: a single institutional experience. Abdom Radiol (NY) 2021; 46:2729-39. [PMID: 33459841 DOI: 10.1007/s00261-020-02948-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/20/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate ultrasound (US) features associated with successful noninvasive management for suspected retained products of conception (RPOC). METHODS In this IRB-approved retrospective study, the radiology report database was queried for pelvic US with keywords of postpartum hemorrhage (PPH) and/or RPOC over a 2-year period. Follow-up exams, US exams without clinical follow-up, suboptimal image quality, and > 1 year from delivery or pregnancy termination were excluded. Charts were reviewed for clinical presentation and management. Two radiologists reviewed images for endometrial thickness, endometrial echogenicity, endometrial vascularity, and enhanced myometrial vascularity (EMV), as well as inner myometrial peak systolic velocity (PSV) and resistive index (RI) where available. Features were assessed for associations with management approach, and test characteristics were calculated. RESULTS Initial query yielded 196 exams, and 48 were excluded. A total of 148 patients were included. Mean age was 34.2 years (21-47), and mean time from delivery or pregnancy termination was 40.4 days (0-223). 81 (55%) underwent noninvasive management: 72 (48%) expectant and 9 (6%) medical. 67 (45%) underwent invasive management: 60 (41%) surgical and 7 (5%) uterine artery embolization. There was substantial inter-reader agreement for assessment of EMV (K = 0.78) and endometrial vascularity (K = 0.72). Thin endometrial stripe, avascular endometrium, and absence of EMV were associated with successful noninvasive management (p < 0.05). Thin endometrium (< 10 mm) had specificity (90%), PPV (88%), and likelihood ratio (5.91) in predicting successful noninvasive management. CONCLUSION Endometrial thickness < 10 mm, avascular endometrium, and absence of EMV are the sonographic features associated with successful noninvasive management for PPH or suspected RPOC.
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9
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O'Rourke-Suchoff D, Benitez S, Higgins MCCS, Stier EA. Diagnosis and treatment of women with radiologic findings suspicious for uterine arteriovenous malformations. J OBSTET GYNAECOL 2020; 41:769-773. [PMID: 33054446 DOI: 10.1080/01443615.2020.1798905] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study investigated the clinical outcomes for patients with pelvic ultrasound findings suspicious for uterine arteriovenous malformations (AVMs) at a single institution. We reviewed the electronic medical record to identify women with pelvic ultrasound reports read as possible uterine AVM, and used medical records to determine clinical outcomes. Among the 39 women with ultrasounds suspicious for AVM, 14 had subsequent MRIs, 10 had additional ultrasounds, and 10 underwent pelvic angiography. Five of the 39 women were ultimately diagnosed with AVMs. Of the 34 women who did not have an AVM, 12 were diagnosed with retained products of conception. Women may be receiving overtreatment for possible uterine AVMs; careful clinical consideration is warranted as the most common clinical diagnosis for women with radiologic findings suspicious of uterine AVM is retained products of conception.Impact statementWhat is already known on the subject: An acquired uterine arteriovenous malformation (AVM) is an abnormal arterio-venous connection in the myometrium that may cause life-threatening haemorrhage. Over the past decade, it has been noted that the characteristic ultrasound findings of uterine AVM may represent other causes of uterine hypervascularity including retained products of conception.What the results of this study add: As there is no consensus on the management of highly vascular myometrial lesions suspicious for uterine AVMs, this study reports our institution's experience with pelvic ultrasound findings suspicious for uterine AVMs. We found that further diagnostic workup, including MRI and angiography were common, but that the most frequent final diagnosis was retained products of conception.What the implications are of these findings for future clinical practice: This study contributes to the growing body of work noting spectrum of conditions with similar vascular ultrasound findings, and suggests that at least in this sample, women may be receiving overtreatment for these presumed uterine AVMs. Close collaboration among gynaecologists and radiologists is needed to interpret the significance of these radiographic images and to determine the appropriate intervention, as women with radiologic findings suspicious of uterine AVM will frequently have retained products of conception.
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Affiliation(s)
| | - Susana Benitez
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Mikhail C C S Higgins
- Division of Interventional Radiology, Department of Radiology, Boston Medical Center, Boston, MA, USA
| | - Elizabeth A Stier
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA, USA.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
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10
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Santonastaso DP, de Chiara A, Russo E, Tognù A, Martino C, Agnoletti V. Erector spinae plane block for pain control after bilateral embolization of uterine arteries: A new possible target. J Clin Anesth 2020; 68:110087. [PMID: 33032126 DOI: 10.1016/j.jclinane.2020.110087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/26/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Domenico P Santonastaso
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy.
| | - Annabella de Chiara
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy.
| | - Emanuele Russo
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - Andrea Tognù
- Section of Anesthesia and Intensive Care Unit, Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy.
| | - Costanza Martino
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy.
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Viale Ghirotti 286, 47521 Cesena, Italy.
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Gallagher N, Cincotta M, Keblawi H, Jude D, Korona M. Uterine arteriovenous malformation leading to postpartum hemorrhage: A case report. Case Rep Womens Health 2020; 28:e00260. [PMID: 33088725 DOI: 10.1016/j.crwh.2020.e00260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022] Open
Abstract
Uterine arteriovenous malformation (AVM) is an uncommon but potentially life-threatening cause of postpartum hemorrhage (PPH). AVMs often present with intermittent or profuse vaginal bleeding in a woman with a history of uterine instrumentation. Transvaginal ultrasound is the initial imaging method used for diagnosis. Management depends on the patient's hemodynamic stability and desire for future pregnancy. Uterine artery embolization (UAE) is the initial treatment option for women of reproductive age. Due to limited evidence, there are no guidelines for the management of failed UAE. Here we report a case of uterine AVM following a cesarean section that failed initial management with UAE and required emergency hysterectomy. Uterine arteriovenous malformation (AVM) is a rare cause of postpartum hemorrhage. Acquired uterine arteriovenous malformations are associated with a history of surgical instrumentation of the uterus. Transvaginal ultrasound is the initial imaging method used for diagnosis. Uterine artery embolization is the first-line treatment for uterine arteriovenous malformations. Hysterectomy is a definitive treatment for uterine arteriovenous malformations refractory to embolization.
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12
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Rampersad F, Narine S, Rampersad D, Diljohn J, Ali R. Uterine arteriovenous malformation mimicking retained products Of conception - treated with embolization. Radiol Case Rep 2020; 15:2076-9. [PMID: 32944104 DOI: 10.1016/j.radcr.2020.08.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 01/11/2023] Open
Abstract
Uterine arteriovenous malformations are uncommon but pose the risk of potentially life-threatening hemorrhage. A 29-year-old pregnant female presented with vaginal spotting, after which ultrasound diagnosis of missed miscarriage was made and medical management undertaken. Vaginal spotting continued post-treatment which led to repeat pelvic ultrasound and subsequent magnetic resonance imaging which confirmed a uterine arteriovenous malformation masquerading as retained products of conception. Uterine instrumentation with dilatation and curettage could have been potentially devastating. The patient was successfully treated with uterine artery embolization.
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13
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Liu SQ, Xie X, Liu YP, Ma YB, Zhang L, Ge HW, Ding JL, Xing XX. Uterine arteriovenous malformation combined with iliac arteriovenous malformation diagnosed by contrast-enhanced ultrasound: A case report and review of the literature. Clin Hemorheol Microcirc 2019; 73:293-298. [PMID: 31156141 DOI: 10.3233/ch-180489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Uterine arteriovenous malformation (AVM) is an extremely rare condition characterized by abnormal connections between veins and arteries. The atypical clinical manifestations and relatively low morbidity of AVM are conducive to missed diagnosis. The present study describes a case of a 47-year-old female patient with congenital uterine AVM followed by iatrogenic AVM. The diagnosis was established by contrast-enhanced ultrasound combined with contrast-enhanced CT (CECT). Because the symptom of vaginal bleeding was severe, trophoblastic disease or neoplasia could be preferred. The manifestations on various imaging examinations were carefully assessed, and the relevant literature was also reviewed.
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Affiliation(s)
- Shui-Qing Liu
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Suzhou University, Changzhou, China
| | - Xiao Xie
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Suzhou University, Changzhou, China
| | - Yan-Ping Liu
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Suzhou University, Changzhou, China
| | - Yi-Bo Ma
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Suzhou University, Changzhou, China
| | - Ling Zhang
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Suzhou University, Changzhou, China
| | - Hong-Wei Ge
- Department of Vascular Surgery, Changzhou First People's Hospital and The Third Affiliated Hospital of Suzhou University, Changzhou, China
| | - Jiu-Le Ding
- Department of Medical Imaging, Changzhou First People's Hospital and The Third Affiliated Hospital of Suzhou University, Changzhou, China
| | - Xiao-Xiao Xing
- Department of Medical Ultrasound, Changzhou First People's Hospital and The Third Affiliated Hospital of Suzhou University, Changzhou, China
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14
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Schwartz E, Faller E, Akladios CY, Greget M, Roy C, Wattiez A. Total Laparoscopic Hysterectomy for Endometriosis and an Arteriovenous Malformation. J Minim Invasive Gynecol 2019; 26:363-4. [PMID: 29772407 DOI: 10.1016/j.jmig.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To show laparoscopic management of an arteriovenous malformation in a patient with deep pelvic endometriosis DESIGN: A step-by-step explanation of the surgery using an instructive video. SETTING Hautepierre University Hospital, Strasbourg, France. INTERVENTIONS We describe the case of a 37-year-old patient presenting with deep pelvic endometriosis and a uterine arteriovenous malformation. Deep pelvic endometriosis was diagnosed during a tubal ligation in 2015. Laparoscopy also showed some pelvic varicosities. Hysteroscopy was performed to increase the diagnostic precision. Huge blood vessels with an arterial pulse on the anterior wall of the uterus were found. The endometriosis of the patient was very symptomatic; she suffered from dysmenorrhea, menorrhagia, intense dyspareunia, and dyschezia. Magnetic resonance imaging indicated a large arteriovenous shunt in the anterior part of the uterus and bladder endometriosis. After a pluridisciplinary medical staff meeting, we decided to begin treatment with luteinizing hormone-releasing hormone analogs. Then, she underwent embolization of the arteriovenous malformation, which produced regression of the lesions as indicated by reevaluation with magnetic resonance imaging. We decided to perform laparoscopic hysterectomy. Evaluation of the abdominal cavity showed diaphragm endometriosis, deep pelvic endometriosis, and the arteriovenous malformation. We started with left ureterolysis and opening of the rectovaginal septum. After that, we radically dissected the left side of the uterus with a left oophorectomy and then the right side, conserving the ovary. Then, we shaved the bladder for endometriosis removal. To finish, we performed a right salpingectomy with a right ovariopexy, vaginal closure, and coagulation of the diaphragm's nodules. The patient agreed to record and publish the surgery, and the local institutional review board gave its approval. CONCLUSION To conclude, preoperative embolization of the arteriovenous shunt improves surgery, avoiding excessive bleeding and permitting easier radical hysterectomy for deep pelvic endometriosis. Similar cases have been published [1], but to our knowledge, our video is the first regarding this subject. It appears that embolization can fail, but hysterectomy remains the gold standard treatment [2].
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15
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Abstract
Background and Objectives: Uterine arteriovenous malformation (AVM) is characterized by shunts between the myometrial arteries and veins. Treatment is based on the severity of uterine bleeding and ranges from conservative medical approaches to embolization of affected arteries. The aim of study was to evaluate the feasibility and safety of hysteroscopy for management of uterine AVM. Methods: This was a retrospective study of a cohort of 11 cases occurring between March 2012 and December 2015 in our Regional Center of Excellence in Hysteroscopy, University of Florence. The diagnosis of AVM was made by transvaginal ultrasonography with high-definition flow in patients with mild to moderate symptoms. In all cases, we used the hysteroscopic platform Gynecare VersaPoint II (Ethicon, Somerville, New Jersey, USA), equipped with a 4-mm electrosurgical loop and associated with the SPIES (Storz Professional Image Enhancement System) system (Karl Storz, Tuttlingen, Germany). Results: All patients were successfully treated with operative hysteroscopy with no reported complications. No patient had residual disease detected by ultrasonography performed after a month. At this writing, of the 11 patients treated with operative hysteroscopy, 4 had achieved a pregnancy that carried to term, 1 was pregnant at 20 wk, and 1 had a miscarriage in the first trimester. Conclusions: Hysteroscopy is a feasible and safe alternative treatment modality for AVM. Patients treated with surgical hysteroscopy have high fertility outcomes, a 100% success rate after the first treatment, no complications related to the surgical procedure, and a short hospital stay.
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Affiliation(s)
- Stefano Calzolari
- Regional Center of Excellence in Hysteroscopy, Palagi Hospital, Florence, Italy
| | - Mauro Cozzolino
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Italy
| | | | - Valeria Dubini
- Regional Center of Excellence in Hysteroscopy, Palagi Hospital, Florence, Italy
| | - Alfonso Farruggia
- Regional Center of Excellence in Hysteroscopy, Palagi Hospital, Florence, Italy
| | - Giovanni Sisti
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Italy
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16
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Tenkumo C, Kanenishi K, AboEllail MAM, Yamamoto K, Ishibashi M, Mori N, Tanaka H, Hata T. HDlive Flow silhouette mode for the diagnosis of uterine enhanced myometrial vascularity/arteriovenous malformations. J Med Ultrason (2001) 2017; 45:349-352. [PMID: 28840423 DOI: 10.1007/s10396-017-0823-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/03/2017] [Indexed: 11/27/2022]
Abstract
We present our initial experience of using the HDlive Flow silhouette mode to construct images of two cases of uterine enhanced myometrial vascularity/arteriovenous malformations (EMV/AVMs). In the first case, the HDlive Flow silhouette mode clearly depicted a fused vascular tumor with irregular contour in the posterior myometrium. In the second case, a large hypervascular mass occupying the entire fundal lesion of the uterus was clearly identified using the HDlive Flow silhouette mode. Moreover, spatial relationships among the hypervascular mass, intrauterine blood collection, and dilated, spiral-shaped right uterine artery enabled the clear localization of the mass. The HDlive Flow silhouette mode provides a novel, unique sonographic image of uterine EMV/AVMs, and might facilitate their diagnosis and localization in the myometrium.
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Affiliation(s)
- Chiaki Tenkumo
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Kenji Kanenishi
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Mohamed Ahmed Mostafa AboEllail
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Kenta Yamamoto
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Megumi Ishibashi
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Nobuhiro Mori
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Hirokazu Tanaka
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Toshiyuki Hata
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan.
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17
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Raherinantenaina F, Rajaonanahary TMA, Randriamandrato TAV, Rakoto Ratsimba HN. [Successful management of an acquired uterine arteriovenous malformation by selective ligation of the internal iliac artery]. ACTA ACUST UNITED AC 2015; 40:182-6. [PMID: 25778842 DOI: 10.1016/j.jmv.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 01/08/2015] [Indexed: 10/23/2022]
Abstract
Uterine arteriovenous malformations can be congenital or acquired. When acquired, they result from abnormal arteriovenous communication between one or more uterine arteries and a myometrial and/or endometrial venous plexus, without the interposition of a vascular nidus. Arteriovenous malformations are composed of a tortuous net of fragile low-resistant arteriovenous shunts. Uterine arteriovenous malformations create a rare and potentially life-threatening condition. The method of treatment is determined by symptoms, desire for future fertility, extent, and location of the malformation. The first treatment option for uterine arteriovenous malformation is hysterectomy, and the second option is uterine artery embolization. Selective ligation of the vessels supplying the malformation is an effective treatment option when conservative methods have failed. The present report describes a patient whose uterine arteriovenous malformation was successfully managed by selective ligation of the internal iliac artery.
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Affiliation(s)
- F Raherinantenaina
- Service de chirurgie générale et vasculaire, CHU/HUJRA, BP 4150, Antananarivo, Madagascar.
| | - T M A Rajaonanahary
- Service de chirurgie générale et vasculaire, CHU/HUJRA, BP 4150, Antananarivo, Madagascar
| | | | - H N Rakoto Ratsimba
- Service de chirurgie générale et vasculaire, CHU/HUJRA, BP 4150, Antananarivo, Madagascar
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18
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Chang KH, Park JK, Park SH, Kim HB, Park ST. Uterine arteriovenous malformation caused by intrauterine instrumentation for laparoscopic surgery due to left tubal pregnancy. Obstet Gynecol Sci 2014; 57:419-23. [PMID: 25264537 DOI: 10.5468/ogs.2014.57.5.419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/04/2014] [Accepted: 05/08/2014] [Indexed: 12/02/2022] Open
Abstract
Uterine arteriovenous malformation (AVM) is a rare entity in gynecology with fewer than 100 cases reported in the literature. Due to abnormal connection between arteries and veins without an intervening capillary system, recurrent and profuse vaginal bleeding is the most common symptom which can be potentially life-threatening. Uterine AVM can be either congenital or acquired. Acquired AVM is reported as a consequence of previous uterine trauma such as curettage procedures, caesarean section or pelvic surgery. It is also associated with infection, retained product of conception, gestational trophoblastic disease, malignancy and exposure to diethlystilboestrol. We herein report a case of acquired uterine AVM located on the right lateral wall after intrauterine instrumentation for laparoscopic left salpingectomy due to left tubal pregnancy. The patient was successfully treated with embolization.
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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20
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Abstract
PURPOSE To evaluate the technical feasibility and clinical outcome of bilateral uterine artery embolization (UAE) as a first-line therapeutic option for bleeding uterine arteriovenous malformation (AVM). MATERIALS AND METHODS Between 2002 and 2012, 19 patients were diagnosed with acquired uterine AVM clinically and through imaging studies. The clinical characteristics, angiographic features, technical success rate of embolization, procedure-related complications, imaging, and clinical follow-up data were assessed. Clinical success was defined as immediate symptomatic resolution with disappearance of vascular abnormality on subsequent imaging studies. RESULTS A total of 20 bilateral UAE, with or without embolization of extra-uterine feeders, were performed as the first-line treatment. Technical and clinical success rate was 90.0% (18/20) and 89.5% (17/19), respectively. Embolization was incomplete in two patients who had residual extra-uterine fine feeders to the AVM or a procedure- related complication (ruptured uterine artery); the former showed slow regression of the vascular malformation during the observation period, while the latter underwent a successful second bilateral UAE. Immediate clinical success was achieved in the remaining 17 patients after a single session and no recurrence of bleeding was found. Recovery to normal menstrual cycle was seen in all 17 patients with clinical success within one or two months, two of whom subsequently had uneventful intrauterine pregnancies carried to term. CONCLUSION Bilateral UAE is a safe and effective first-line therapeutic option for the management of bleeding uterine AVMs. However, incomplete embolization due to unembolizable feeders or difficult access into the uterine artery may lead to suboptimal treatment.
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Affiliation(s)
- Taehwan Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea.
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21
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Abstract
Uterine arteriovenous vascular malformations (UAVM) are uncommon vascular diseases, occurring during reproductive age. Patients affected by UAMVs usually present with recurrent pregnancy loss or menorrhagia. Initial evaluation of UAVMs is made with ultrasonography (US) and US-Doppler. Magnetic resonance is used when a UAMV is suspected at US. Treatment can be surgical (hysterectomy or surgical removal of AVM), or with selective uterine arterial embolization. We report a case of UAMV, from its clinical signs to diagnostic confirmation and subsequent treatment.
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22
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Chen Y, Wang G, Xie F, Wang B, Tao G, Kong B. Embolization of uterine arteriovenous malformation. Iran J Reprod Med 2013; 11:159-66. [PMID: 24639742 PMCID: PMC3941356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 06/06/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Uterine arteriovenous malformation is a rare but potential life-threatening source of bleeding. A high index of suspicion and accurate diagnosis of the condition in a timely manor are essential because instrumentation that is often used for other sources of uterine bleeding can be lead to massive hemorrhage. CASE We describe here a case of uterine arteriovenous malformation. A 32-year-old woman presented abnormal vaginal bleeding following the induced abortion. A diagnosis of uterine arteriovenous malformation made on the basis of Doppler ultrasonraphy was confirmed through pelvic angiography. The embolization of bilateral uterine arteries was performed successfully. CONCLUSION Uterine arteriovenous malformation should be suspected in patient with abnormal vaginal bleeding, especially who had the past medical history incluing cesarean section, induced abortion, or Dillation and Curethage and so on. Although angiography remains the gold standard, Doppler ultrasonography is also a good noninvasive technique. The transcatheter uterine artery embolization offers a safe and effective treatment.
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Affiliation(s)
- Yan Chen
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, China.
| | - Guoyun Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, China.
| | - Fubo Xie
- Department of Interventional Radiology, Qilu Hospital of Shandong University, Jinan 250012, China.
| | - Bo Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, China.
| | - Guowei Tao
- Department of Ultrasonography, Qilu Hospital of Shandong University, Jinan 250012, China.
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, China.
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