Outcomes After Uterine Artery Embolization and Other Treatment Modalities for Uterine Arteriovenous Malformation: A Multicenter Review from the Society of Gynecologic Surgeons Fellows Pelvic Research Network

Abstract

Study Objective To compare treatment outcomes between women managed with uterine artery embolization (UAE) and women treated with other modalities for uterine arteriovenous malformations (AVM) Design Retrospective cohort Setting Five academic centers participating in the Fellows’ Pelvic Research Network (FPRN) Patients or Participants Women 18 years or older with pelvic ultrasound or other imaging diagnosis of uterine AVM between January 2006 and December 2013 Interventions Patients received either UAE or other conservative treatment options, which varied based on provider preference. Other treatment options included expectant management, hormones, methylergonovine, dilation and curettage (D&C), tranexamic acid. Women who underwent hysterectomy as first-line treatment were excluded. Measurements and Main Results Chart review was performed to gather data. Preliminary data analysis of 23 patients who met inclusion criteria at 3 different sites was performed. Twenty-one women (91.3%) underwent ultrasound and 6 (26.1%) ultimately had angiography while one patient had magnetic resonance angiography (MRA) performed. Of the 7 patients who had angiography or MRA, 5 confirmed a true uterine AVM. The majority of women presented with abnormal bleeding (82.6%). For first-line treatment, 5 patients underwent UAE, 14 had expectant management, 3 were given methylergonovine (1 patient was administered IV conjugated estrogen concurrently), 3 were given oral contraceptive pills, 2 underwent D&C, 1 patient underwent hysteroscopic resection, 1 received tranexamic acid and 1 patient received medroxyprogesterone acetate. Five patients were managed with a second-line treatment, 13 did not require additional treatment and 5 patients were lost to follow up. Fourteen patients had documented resolution. Conclusion Uterine AVM occur very infrequently but should be considered in the differential diagnosis of abnormal uterine bleeding. Although initial imaging showed concern for a uterine AVM, at least 2 of 7 patients who underwent subsequent angiography did not confirm the diagnosis. In women with concern for AVM, confirmatory imaging should be performed prior to any treatment that may affect future fertility.