Precipitating hydrophobic injectable liquid (PHIL) embolic for the treatment of a uterine arteriovenous malformation: a technical report

Dylan Kurda,Julian Maingard,Hong Kuan Kok,Geetha Guduguntla,Shivendra Lalloo

doi:10.1186/s42155-019-0059-z

Abstract

ObjectiveUterine 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 reportA 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.ConclusionUterine AVM can be treated safely and effectively with UAE using PHIL.

Highlights

Uterine arteriovenous malformation (AVM) is a rare cause of menorrhagia that may cause life threatening bleeding
Uterine artery embolization (UAE) is one of the therapeutic options, for which several embolic agents have been mentioned in literature
The first successful transarterial embolization for uncontrolled uterine bleeding from fibroids was performed in 1974 by Jean-Jaques Merland (Yoon et al, 2016; Sellers et al, 2013) and UAE is an established first-line treatment option for symptomatic fibroids

Summary

Introduction

Uterine arteriovenous malformation (AVM) is a rare cause of menorrhagia that may cause life threatening bleeding. The diagnosis is most commonly established by pelvic ultrasound other cross-sectional imaging modalities including CT and MRI are helpful. Uterine artery embolization (UAE) is one of the therapeutic options, for which several embolic agents have been mentioned in literature. The first successful transarterial embolization for uncontrolled uterine bleeding from fibroids was performed in 1974 by Jean-Jaques Merland (Yoon et al, 2016; Sellers et al, 2013) and UAE is an established first-line treatment option for symptomatic fibroids. There is more limited experience with UAE for treatment of uterine AVM, the choice of technique and embolic agent can impact on the success of

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Conclusion