1:00 PM Abstract No. 10 - Embolization of uterine AVMs: an 11 year single center experience

Abstract

PurposeTo review our experience with endovascular embolization of uterine AVMs.Materials and MethodsBetween 2002 and 2013, 11 women with uterine AVMs were seen and treated at our institution via diagnostic arteriography and superselective uterine artery (UA) embolization with a variety of agents including calibrated microspheres, surgical gelatin pledgets and ethylene vinyl alcohol copolymer (Onyx), direct puncture with ethanol or venous outflow coiling. Clinical and imaging followup was obtained.ResultsEleven women (27-45 yr) with uterine AVMs and vaginal bleeding (10/11) and/or pain (6/11) were treated. One patient was asymptomatic. The diagnosis was initially made by ultrasound (10/11) or CT (1) and subsequently confirmed with a combination of MR and CT in all 11. 10/11 had been pregnant in the past with 7 women having delivered normal infants vaginally or via C-section; 2 had a history of treated molar pregnancy or trophoblastic disease and 2 had recently electively terminated a pregnancy. There were 15 embolization sessions; 3 women had 2 or more embolizations. Agents used for UA embolizations were calibrated microspheres and surgical gelatin (10), Onyx only (3), direct puncture with ethanol (1) and venous outflow coiling (1). In followup, 8 patients were cured and 3 failed therapy and required partial or complete hysterectomy. Two women achieved subsequent pregnancy and delivered normal term infants.ConclusionUterine AVMs are generally associated with prior obstetric history and can be successfully treated with a variety of particulate or liquid embolic agents to preserve the uterus and permit subsequent pregnancy. PurposeTo review our experience with endovascular embolization of uterine AVMs. To review our experience with endovascular embolization of uterine AVMs. Materials and MethodsBetween 2002 and 2013, 11 women with uterine AVMs were seen and treated at our institution via diagnostic arteriography and superselective uterine artery (UA) embolization with a variety of agents including calibrated microspheres, surgical gelatin pledgets and ethylene vinyl alcohol copolymer (Onyx), direct puncture with ethanol or venous outflow coiling. Clinical and imaging followup was obtained. Between 2002 and 2013, 11 women with uterine AVMs were seen and treated at our institution via diagnostic arteriography and superselective uterine artery (UA) embolization with a variety of agents including calibrated microspheres, surgical gelatin pledgets and ethylene vinyl alcohol copolymer (Onyx), direct puncture with ethanol or venous outflow coiling. Clinical and imaging followup was obtained. ResultsEleven women (27-45 yr) with uterine AVMs and vaginal bleeding (10/11) and/or pain (6/11) were treated. One patient was asymptomatic. The diagnosis was initially made by ultrasound (10/11) or CT (1) and subsequently confirmed with a combination of MR and CT in all 11. 10/11 had been pregnant in the past with 7 women having delivered normal infants vaginally or via C-section; 2 had a history of treated molar pregnancy or trophoblastic disease and 2 had recently electively terminated a pregnancy. There were 15 embolization sessions; 3 women had 2 or more embolizations. Agents used for UA embolizations were calibrated microspheres and surgical gelatin (10), Onyx only (3), direct puncture with ethanol (1) and venous outflow coiling (1). In followup, 8 patients were cured and 3 failed therapy and required partial or complete hysterectomy. Two women achieved subsequent pregnancy and delivered normal term infants. Eleven women (27-45 yr) with uterine AVMs and vaginal bleeding (10/11) and/or pain (6/11) were treated. One patient was asymptomatic. The diagnosis was initially made by ultrasound (10/11) or CT (1) and subsequently confirmed with a combination of MR and CT in all 11. 10/11 had been pregnant in the past with 7 women having delivered normal infants vaginally or via C-section; 2 had a history of treated molar pregnancy or trophoblastic disease and 2 had recently electively terminated a pregnancy. There were 15 embolization sessions; 3 women had 2 or more embolizations. Agents used for UA embolizations were calibrated microspheres and surgical gelatin (10), Onyx only (3), direct puncture with ethanol (1) and venous outflow coiling (1). In followup, 8 patients were cured and 3 failed therapy and required partial or complete hysterectomy. Two women achieved subsequent pregnancy and delivered normal term infants. ConclusionUterine AVMs are generally associated with prior obstetric history and can be successfully treated with a variety of particulate or liquid embolic agents to preserve the uterus and permit subsequent pregnancy. Uterine AVMs are generally associated with prior obstetric history and can be successfully treated with a variety of particulate or liquid embolic agents to preserve the uterus and permit subsequent pregnancy.