Treatment Of Uterine Arteriovenous Malformation Research Articles

Role of Laparoscopy in Treatment of Uterine Arteriovenous Malformation after Failure of Uterine Arteries Embolization

Role of Laparoscopy in Treatment of Uterine Arteriovenous Malformation after Failure of Uterine Arteries Embolization

"Treatment of Uterine Arteriovenous Malformation and Subsequent Successful Pregnancy: A Case Report"

"Treatment of Uterine Arteriovenous Malformation and Subsequent Successful Pregnancy: A Case Report"

Successful treatment of uterine arteriovenous malformation by conservative management: Case report

Successful treatment of uterine arteriovenous malformation by conservative management: Case report

Medical Treatment of Uterine Arteriovenous Malformation: A Systematic Review and Meta-Analysis

<h3>Study Objective</h3> To quantify the efficacy of medical management of uterine arteriovenous malformation (AVM) and compare efficacy between different classes of medication. We also evaluated for factors associated with treatment success and pregnancy outcomes following medical management. <h3>Design</h3> Systematic review and metanalysis. <h3>Setting</h3> Not applicable. <h3>Patients or Participants</h3> Thirty-two studies representing 121 premenopausal women with medically treated uterine AVM were identified via database searches of MEDLINE, Embase, Web of Science and cited references. <h3>Interventions</h3> Medical treatment with progestins, gonadotropin-releasing hormone agonists (GnRH-a), methotrexate, combined hormonal contraception (CHC), uterotonics, danazol, or combination of the above. <h3>Measurements and Main Results</h3> The primary outcome of treatment success was defined as AVM resolution without subsequent procedural interventions. Secondary outcome was treatment complication (re-admission or transfusion). The unadjusted overall success rate of medical management was 88% (106/121), while individual agent success rates were progestins (82.5%), GnRH-a (89.3%), methotrexate (90.9%), CHC (42.8%), uterotonics (100%), and danazol (66.6%). After adjusting for clustering effects, success rates for progestin (82.5%, 95% CI 70.1% to 90.4%, <0.001), GnRH-a (89.3%, 95% CI 71.4% to 96.5%, p<0.001) and methotrexate (90.0%, 95% CI 55.8% to 98.8%, p=0.028) were significantly different from the null hypothesis of 50% success. In a pairwise comparisons, progestins (OR 6.29, 95% CI 1.19 to 33.17, p=0.030) and GnRH-a (OR 11.13, 95% CI 1.63 to 76.10, p=0.014) were more efficacious compared to CHC. The agents with the lowest adjusted proportion of complications were progestins (10.0%, 95% CI 3.3% to 26.8%, p<0.001) and GnRH-a (10.7%, 95% CI 3.5% to 28.4%, p<0.001). No clinical factors were found to predict treatment success. Twenty-six subsequent pregnancies are described, with no reported recurrences of AVM. <h3>Conclusion</h3> Primary medical management for symptomatic uterine AVM is a reasonable approach in a well selected patient. This data should be interpreted in the context of significant publication bias.

Medical treatment of uterine arteriovenous malformation: a systematic review and meta-analysis

To quantify the efficacy of medical management of uterine arteriovenous malformation (AVM) and compare efficacy between different classes of medication. In addition, we evaluated for factors associated with treatment success and pregnancy outcomes after medical management. Systematic review and meta-analysis. Not applicable. Thirty-two studies representing 121 premenopausal women with medically-treated uterine AVM were identified via database searches of MEDLINE, Embase, Web of Science, and cited references. Medical treatment with progestins, gonadotropin-releasing hormone agonists (GnRH-a), methotrexate, combined hormonal contraception , uterotonics, danazol, or combination of the above. Primary outcome of treatment success was defined as AVM resolution without subsequent procedural interventions. Secondary outcome was treatment complication (readmission or transfusion). The overall success rate of medical management was 88% (106/121). After adjusting for clustering effects, success rates for progestin (82.5%; 95% confidence interval [CI], 70.1%-90.4%), GnRH-a (89.3%; 99% CI, 71.4%-96.5%) and methotrexate (90.0%; 99% CI, 55.8%-98.8%) were significantly different from the null hypothesis of 50% success. The agents with the lowest adjusted proportion of complications were progestins (10.0%; 99% CI, 3.3%-26.8%) and GnRH-a (10.7%; 99% CI, 3.5%-28.4%). No clinical factors were found to predict treatment success. Twenty-six subsequent pregnancies are described, with no reported recurrences of AVM. Medical management for uterine AVM is a reasonable approach in a well selected patient. These data should be interpreted in the context of significant publication bias.

Stepwise Treatment of Uterine Arteriovenous Malformation Complicated by a Giant Aneurysm: A Case Report

Uterine arteriovenous malformation (AVM) is a rare condition that threatens severe uterine bleeding. We present a patient with this pathology, who was hospitalized twice within 5 months in serious condition, because she refused a hysterectomy. Ultrasonography of the uterus detected a vascular formation, the nature of which could be identified only on computed tomography (CT) angiography. Afferent vessels were embolized twice, and after the condition was stabilized, we performed a hysterectomy. For a long time, there was no recurrence of bleeding. The foregoing allows us to recommend the described tactics for the diagnosis and treatment of uterine AVM in women in similar clinical situations.

Successful Treatment of Uterine Arteriovenous Malformation due to Uterine Trauma.

Uterine arteriovenous malformation (AVM) is defined as abnormal and nonfunctional connections between the uterine arteries and veins. Although the patients typically present with vaginal bleeding, some patients may experience life-threatening massive bleeding in some circumstances. The treatment of choice depends on the symptoms, age, desire for future fertility, and localization and size of the lesion; however, embolization of the uterine artery is the first choice in symptomatic AVM in patients at reproductive age with expectations of future fertility. We report a case of acquired AVM (after D/C) with an extensive lesion, which was successfully treated with bilateral uterine artery embolization (UAE).

Acquired Arteriovenous Malformation Definition: An Improper Use in Diagnostic Radiology Practice

We read with interest the article by Dr. Rangarajan and colleagues [1] in the November–December 2007 issue of CardioVascular & Interventional Radiology regarding a case of successful endovascular treatment of uterine arteriovenous malformation (AVM). The diagnosis was suggested by color Doppler ultrasound (US) examination, while magnetic resonance imaging demonstrated pathological vessels within the uterine fundus at the site of the US abnormality, compatible with the diagnosis of AVM. The authors wrote that ‘‘acquired AVMs are more common than the congenital form, usually resulting from instrumentation or as a complication of malignancy, fibroids, endometriosis, or gestational trophoblastic disease.’’ AVMs or arteriovenous hemangiomas are composed of variable numbers of tortuous, dilated, thinand thick-walled vessels of varying size, usually with at least a focal presence of an internal elastic lamina [2]. Two hundred seventy-eight cases of AVM are reported in the gynecologic and radiologic literature, without histological documentation except for the case of Chien et al. [3]. Recently, we observed a uterine AVM in a 72-year-old woman. The diagnosis of AVM was suggested by color Doppler US findings and confirmed histologically on a hysterectomy specimen. The term acquired AVM has been widely and improperly used in the radiologic literature and shoud be avoided. The term ‘‘malformation’’ implies a congenital etiology. A malformation is defined as a primary structural defect that results from a localized error of morphogenesis within the first 8 weeks following conception. More subtle defects within organs can arise at a later stage of development; remodeling during later growth of tissue which has been damaged after normal organogenesis can result in an abnormal structure by the time of birth [4]. An AVM may only be congenital and cannot be the complication of other uterine disease. Use of the term acquired AVM should be avoided when histological documentation is not available. In the radiological report the diagnosis of the lesion should be ‘‘descriptive’’ of vascular uterine abnormality. In studies of 25 embolization procedures performed in 15 patients, Ghai et al. [5] emphasize that the term ‘‘malformation’’ implies a developmental origin and that it is therefore improper to use this term in the context of acquired AVM. In conclusion, the term ‘‘arteriovenous fistula’’ or ‘‘arteriovenous shunt’’ should be used instead for acquired AVM in diagnostic radiology practice.

Successful Treatment of Uterine Arteriovenous Malformation with Percutaneous Embolization

Uterine arteriovenous malformation (AVM) is a rare condition and can be life-threatening if not managed properly. We report a case that was diagnosed by typical ultrasound imaging and treated successfully with uterine arterial embolization. A 28-year-old female, gravida 4, para 3, abortus 1, presented with massive vaginal bleeding 19 days after a termination of pregnancy due to fetal anomaly. After a dilatation and curettage 3 years previously, typical ultrasound image findings and a declining pattern of serum beta-hCG (human chorionic gonadotrophin), acquired AVM was highly suspected. 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 6 weeks after embolization. AVM can be diagnosed at an early stage with the aid of history taking and ultrasound. Percutaneous embolotherapy is a safe and effective treatment for AVM, especially when fertility preservation is desired.