Uterine Arteriovenous Malformation Research Articles

Sonographic Features of Uterine Arteriovenous Malformation: A Case Series.

Uterine arteriovenous malformation (AVM) is very rare but potentially life-threatening. Early and accurate diagnosis is the cornerstone of its management. The objective of this study is to encourage sonographers to become familiar with a variety of grayscale sonographic features, facilitating rapid recognition of the patterns and prompting them to apply color flow Doppler for a diagnosis of uterine AVM and possible further investigations or interventions. We present six cases of uterine AVM presenting with abnormal uterine bleeding at varying degrees of severity, from abnormal menstruation to life-threatening bleeding following curettage. All initially provided some clues of uterine AVM upon grayscale ultrasound, leading to the application of color Doppler flow to support a diagnosis, with confirmation using abdominal computer tomography angiography (CTA) in most cases, resulting in definitive treatment using uterine artery embolization or other interventions. Most importantly, this study provides various sonographic features of uterine AVM, such as appearances of small tubular structures, spongy patterns, a conceptive-product-like appearance, and spaghetti-like patterns. Hopefully, familiarity with these sonographic features can facilitate practitioners to make an early diagnosis, leading to proper further investigation and intervention, and to prevent serious complications from potentially being caused by this subtle but very serious disorder.

Acquired Uterine Arteriovenous Malformation: Treatment with Uterine Artery Embolization for CME Credit March 2024

Acquired Uterine Arteriovenous Malformation: Treatment with Uterine Artery Embolization for CME Credit March 2024

Uterine vascular abnormalities linked to pregnancy complications: color and power Doppler-assisted transvaginal ultrasound evaluation.

Abnormal uterine vascular pattern can be observed during transvaginal ultrasound examination used for investigating post-abortion bleeding and secondary postpartum hemorrhage. The purpose of this series of cases was to evaluate almost all the rare causes of uterine vascular abnormalities linked to pregnancy complications, and determine how to arrive at the diagnosis to optimize patient management, which is crucial for preventing life-threatening massive vaginal bleeding. Retrospective observational case series study including 20 women with postpartum or post-abortion vaginal bleeding who were found to have an abnormal uterine vascular pattern during a transvaginal color duplex assessment. The study yielded the following findings: 10 cases of enhanced myometrial vascularity, two cases of pseudoaneurysm in the uterine artery, one case of myometrial venous varix, one case of large uterine venous pseudoaneurysm, one case of uterine arteriovenous malformation, one case of retained placental polyp, one case of invasive vesicular mole, and three cases of subinvolution of the placental implantation site. Transvaginal color duplex ultrasound plays a crucial role in detecting uterine vascular abnormalities as a cause of post-abortion or secondary postpartum hemorrhage and can help differentiate the pathologies responsible for the abnormal vascular pattern, which is highly recommended to optimize patient management.

Acquired Uterine Arteriovenous Malformation: Treatment With Uterine Artery Embolization

Enhanced myometrial vascularity/uterine arteriovenous malformations (EVM/AVM) are a rare cause of vaginal bleeding that can result in life-threatening hemorrhage if left untreated. Enhanced myometrial vascularity/uterine arteriovenous malformations arise from an abnormal connection between arteries and veins without an intervening capillary network and can be acquired as a result of retained products of conception, uterine trauma, or surgical intervention. Enhanced myometrial vascularity/uterine arteriovenous malformations are typically present in women of childbearing age with intermittent to profuse vaginal bleeding symptoms. The diagnosis is typically made by transabdominal or transvaginal ultrasound with color Doppler followed by computed tomography angiography or magnetic resonance imaging to assess the extent of the malformation and visualize any feeding arteries. Treatment varies based on symptoms, age, patient preferences, and desire for future fertility and includes conservative therapy, uterine artery embolization, and hysterectomy. We report 3 cases of EVM/AVM, which were imaged and diagnosed utilizing ultrasonography and successfully treated with uterine artery embolization.

Uterine Arteriovenous Malformation, Grey- Scale and Colour Doppler findings: A Case Report and Review

Introduction: Uterine arteriovenous malformations can either be congenital or acquired and are rare vascular disorders seen in women of child bearing age, with varied presentation. The clinical features range from being asymptomatic to life threatening haemorrhage. Imaging, particularly grey scale and color Doppler ultrasonography play a major role in the prompt diagnosis of this condition as the findings are useful when differentiating between the types as well as in planning the management of these patients. Objectives: To make a report of a rare case of arteriovenous malformation of the uterus in a young female patient with a review of relevant literature as well as to highlight the importance of Colour Doppler ultrasonography in the evaluation of uterine lesions. Case Presentation: The case is of a 36year old female patient with a 2 years history of amenorrhoea following multiple sessions of dilatation and curettage. She also had chemotherapy due to choriocarcinoma. Pregnancy test was negative. Pelvic ultrasound scan done showed multiple cystic tubular spaces that were hypervascular on colour Doppler interrogation. High velocities and low RI values were recorded. Conclusion: Uterine arteriovenous malformations (AVMs) are important rare vascular disorders of the uterine vessels that need to be recognized early on imaging for appropriate management to be instituted.

Clinical experience with postpartum treatment of a patient with arteriovenous malformation of uterine vessels

Uterine arteriovenous malformation is a rare vascular dysplasia where the uterine veins communicate with the branches of arteries of varying calibers. Patient K., a 37-years-old patient, presented with genital tract bleeding. Her medical history included operative labor at 37 weeks with dichorionic diamniotic twins, with the placental site on the posterior uterine wall exhibited firm attachment. The uterine cavity walls were scraped, and the bleeding vessel in the placental site was sutured. The blood loss amounted to 750 mL, and reinfusion was conducted. Fourteen days after giving birth, a heavy bloody discharge with blood clots from the genital tract occurred. The blood tests revealed no abnormalities. Echography detected multiple tubular structures that were anechoic on the posterior wall of the uterus, from the endometrium to the serosa, with the CDC mode blood flow. Magnetic resonance angiography revealed hypervascularization with premature arteriovenous discharge. Superselective embolization was performed on uterine artery afferents, and complete blood flow reduction was achieved, leading to the cessation of bleeding. On postoperative day 17, the patient experienced considerable bloody discharge from the genital tract, causing the hemoglobin level to decrease to 88 g/L. The presence of an arteriovenous malformation in the uterine vessels accompanied by ineffective embolization necessitated uterine extirpation. The postoperative phase was uneventful, and the patient was discharged from the hospital in satisfactory condition, with no evidence of anemia (hemoglobin, 115 g/L).

The Use of Methotrexate and Mifepristone for Treatment of Interstitial Pregnancies: An Overview of Effectiveness and Complications

Interstitial pregnancy is an unusual and potentially life-threatening form of ectopic pregnancy, accounting for approximately 1–6% of all ectopic pregnancies, with a maternal mortality rate of 2–2.5%. Implantation happens in the proximal portion of the fallopian tube as it passes through the myometrium. The resolution of interstitial pregnancy after medical treatment should be assessed by a decline in serum β-hCG, which occurs in about 85–90% of cases. Nonetheless, its effectiveness and consequences have been presented through case reports and case series. However, few cases of interstitial pregnancies treated totally medically with the use of methotrexate and mifepristone have been presented in the literature. Complications of this medical treatments have also never been reviewed before. In the present manuscript, we present a case of interstitial pregnancy treated with methotrexate and mifepristone. The patient after treatment developed a uterine arteriovenous malformation, treated with uterine artery embolization. Furthermore, we performed a systematic review of the literature using Scopus, PubMed and Google Scholar. A total of 186 papers were found, and 7 papers which included 10 cases were assessed for eligibility. The systemic medical treatment with the use of methotrexate and mifepristone was effective in 7 of the 10 cases. Two cases of hemoperitoneum following combined methotrexate and mifepristone treatment were reported. The applicability of this medical conservative treatment should be tailored to the patient, taking into account their obstetric history, gestational age at diagnosis and desire for future pregnancies. Complete resolution after this treatment was achieved in most of the cases reported without major complications. The appearance of uterine arteriovenous malformation can be managed conservatively, and we propose uterine artery embolization as an effective treatment of this rare complication.

Repair of Isthmocele Following Embolization of Uterine Arteriovenous Malformation

To present a case of concurrent uterine arteriovenous malformation (AVM) and isthmocele, treated with ethylene vinyl alcohol copolymer (EVAC) embolization of the AVM followed by robotic isthmocele repair. A stepwise video demonstration with narration. A tertiary care academic hospital. Patient is a 37-year-old with one previous cesarean section who presented with persistent heavy vaginal bleeding after a dilation and evacuation procedure. Imaging showed evidence of an isthmocele and an iatrogenic uterine AVM secondary to the dilation and evacuation procedure. Both entities are morbid conditions associated with significant operative blood loss. Embolization of the acquired AVM was first performed to stabilize bleeding. In addition, owing to the extensive uterine defect and history of infertility, surgical repair of the isthmocele was recommended. A multidisciplinary approach combining interventional radiology and gynecologic surgery expertise, implementing several strategies to minimize blood loss: 1. Image-guided uterine AVM embolization with EVAC [1] 2. Hysteroscopic identification of isthmocele and residual EVAC in the cavity, with fluorescence transillumination to clearly delineate isthmocele borders 3. Robot-assisted laparoscopic approach for bladder flap creation, as well as retroperitoneal space dissection to skeletonize uterine arteries 4. Transient occlusion of uterine arteries using vascular clamps to minimize operative blood loss given the isthmocele size and its proximity to the left uterine artery 5. Resection of the isthmocele and removal of residual intracavitary EVAC 6. Multilayer, bidirectional hysterotomy closure and vascular clamp removal to restore uterine blood supply CONCLUSIONS: Successful multidisciplinary treatment of concurrent uterine AVM and isthmocele. Cesarean delivery at 36 to 37 weeks' gestational age was recommended for future deliveries.

EP16.12: Unusual location of placenta accreta after uterine artery embolisation for uterine arteriovenous malformation: a case report

EP16.12: Unusual location of placenta accreta after uterine artery embolisation for uterine arteriovenous malformation: a case report

Uterine arteriovenous malformation complicated by a scar ectopic pregnancy

Uterine arteriovenous malformation complicated by a scar ectopic pregnancy

Uterine Arteriovenous Malformation: A Near-Missed Fatal Misdiagnosis?

Less than 100 cases of uterine arteriovenous malformations (AVM) have been documented. The true incidence remains unknown with 30% complicated by hypovolemic shock. Women who experience unexplained vaginal bleeding may consider this diagnosis. We chose to emphasize this case because, while being a rare disease, it could cause mortality if misdiagnosed. In this case, a 23-year-old lady, para 1+2 with a history of several miscarriages and curettage, complained of per vaginal bleeding more than 2 months after her suction and curettage on September 2018. Her second visit was managed as having retained product of conception and another curettage was conducted. Despite this, the patient still has worsening vaginal bleeding which leads to her third visit. A bedside ultrasound was conducted and suspected uterine AVM. This was then further confirmed with contrast-enhanced computed tomography of the pelvis and pelvis angiography. Five Micronester coils and 10% Histoacryl adhesive were used to successfully embolize the uterine artery. This case report served as a valuable lesson on the importance of having a proper diagnosis and prompt treatment to avoid fatal misdiagnosis which could have disastrous consequences.

Effect of direct surgical treatment in pregnancy-related uterine arteriovenous malformation

BackgroundUterine arteriovenous malformation (UAVM) is a relatively rare but potentially life-threatening situations abnormal vascular connections between the uterine arterial and venous systems. Lack of recognized guidelines and clinic experience, there is a lot of clinic problems about diagnosis and treatment. By analyzing the clinical data of patients with pregnancy-related UAVM, we aim to confirm the safety of direct surgeries and the benefit of pretreatment (uterine artery embolization or medical therapy) before surgery, and to explore more optimal therapies for patients with pregnancy-related UAVM.MethodsA total of 106 patients in Qilu Hospital of Shandong University from January 2011 to December 2021 diagnosed of pregnancy-related UAVM were involved in this study. Depending on whether preoperative intervention was performed, the patients were divided into direct surgery group and pretreatment group (uterine artery embolization or medical management). Clinical characteristics, operative related factors and prognosis were analyzed.ResultsThe most common symptom of pregnancy-related UAVM was vaginal bleeding (82.5%), which could also be accompanied by abdominal pain. Pretreatments (uterine artery embolization or medical therapy) had no obvious benefit to the subsequent surgeries, but increased the hospital stay and hospital cost. Direct surgery group had satisfactory success rate and prognosis compared to pretreatment group.ConclusionFor pregnancy-related UAVM, direct surgery has good effects and high safety with shorter hospital stays and less hospital cost. What is more, without uterine artery embolization and other medical therapy, patients could remain better fertility in future.

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

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

Uterine venous malformations in the puerperium: 2 Atypical cases and literature review.

Uterine arteriovenous malformations (AVMs) is a rare but high-risk cause of uterine bleeding. The clinical management of this condition is challenging, as the ultrasound picture can sometimes be unambiguously interpreted. Moreover, in the puerperium in which acquired AVMs are most frequently formed, it is necessary to discuss the correct management in a multidisciplinary and personalized manner. We present two cases of AVMs developing in the puerperium, both with a vaginal delivery and spontaneous and complete secondment. The symptom of onset was an episode of bright red blood loss in the puerperium, on the 14th and 21st postpartum days, respectively. Transvaginal ultrasound showed a hypervascularized lesion in the myometrium with turbulent vascular flow, confirmed by transabdominal ultrasound and angiography. To date, there are no guidelines on the management of MAVs. In our cases we opted for a conservative approach, in order to preserve the fertility of the patient. These experiences reported have the purpose of enriching a literature still sparse on the subject and in the future to be able to represent a fulcrum for official recommendations.

Persistent cornual pregnancy mimicking uterine arteriovenous malformation: a case report

BackgroundUterine 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 presentationHere 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.ConclusionUterine 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.

Enhanced myometrial vascularity and AVM: A review on diagnosis and management.

Uterine Arteriovenous malformations (AVM) are vascular disorders characterized by complex high-flow tangles of abnormal vessels connecting arteries and veins with bypassing capillaries. Recently, the terminology applied to describe uterine AVMs has been modified. Most AVMs are acquired. The term enhanced myometrial vascularity (EMV) is used to describe any condition in which any uterine pathology may lead to increased myometrial vascularity regardless of the absence or presence of residual tissue of gestation.

Efficacy of Embolization in Acquired Uterine Vascular Malformations: An Experience in Tertiary Care Centre in India.

To determine the efficacy of Uterine Artery Embolization in patients with bleeding acquired uterine arteriovenous malformations (AVMs). A prospective review of all patients who underwent Uterine Artery Embolization at our institution between July 2015 and April 2022 was performed. 225 patients were diagnosed with a uterine vascular malformation on doppler and corresponding MRI imaging. All patients underwent transcatheter embolization of the uterine arteries. Embolic agents in the 375 procedures included Histoacryl glue only (n = 326), polyvinyl alcohol (PVA) particles and Histoacryl glue (n = 29), PVA particles (n = 5), Gelfoam (n = 5), coils (n = 4), PVA particles and coils (n = 3), Histoacryl glue and Gelfoam (n = 2), and Histoacryl glue and coils (n = 1). A total of 375 embolization procedures were performed in 225 patients. 90 patients required repeat embolization for recurrence of bleeding. The technical success rate of embolization was 100%. The clinical success rate was 92%: bleeding was controlled in 222 of 225 patients and three patients underwent a hysterectomy. 60 of the 225 patients had uneventful intrauterine pregnancies carried to term. The 210 patients who underwent successful embolization had no recurrence of bleeding at a median follow-up of 53 months (range, 5-122 months) after treatment. 15 patients were eventually lost to follow-up. One minor complication (0.4%) of non-flow-limiting dissection of the internal iliac artery occurred. Uterine Artery Embolization is a safe, effective, minimally invasive method to treat uterine AVMs with long-term efficacy, which can provide the preservation of fertility.

POSTPARTUM UTERINE ARTERIOVENOUS MALFORMATION: A CASE REPORT

Uterine arteriovenous malformations can be congenital or acquired. The acquired form results from arteriovenous anomalies in which one or more uterine arteries and venous plexuses from the endometrium and/or myometrium communicate without the interposition of a vascular nest. It is composed of tortuous arteriovenous shunts, fragile and with low resistance. It is a rare but serious pathology that can threaten the patients prognosis. The therapeutic strategy is determined by the symptoms, the desire for subsequent pregnancy, the extension and the location of the malformation. The two main types of treatment are selective embolization and hysterectomy. We report a new case of postpartum arteriovenous malformation treated by hysterectomy after failure of conservative treatment by ligation of the internal iliac arteries. The anatomopathological examination of the hysterectomy specimen confirmed the diagnosis of AVM.

Total hysterectomy in uterine arteriovenous malformation refractory to re-embolization: a case report.

Total hysterectomy in uterine arteriovenous malformation refractory to re-embolization: a case report.

Repair of Isthmocele Following Embolization of Uterine Arteriovenous Malformation

<h3>Study Objective</h3> Discuss advantages of ethylene vinyl alcohol copolymer (EVAC) use for uterine arterio-venous malformation (AVM). Demonstrate technique for vascular control during robotic repair of isthmocele. <h3>Design</h3> Video documentation of the surgical procedure (instructive video). <h3>Setting</h3> University of California, San Francisco Hospital operating room with patient placed in dorsal lithotomy positioning. <h3>Patients or Participants</h3> A 37-year-old woman, status-post embolization of uterine AVM, presenting with a 3.5 × 2.5 cm uterine isthmocele. <h3>Interventions</h3> Discuss embolization of a uterine AVM. Then, present a case of AVM with isthmocele, review the patient's imaging, and show a stepwise approach to the procedure. Hysteroscopy is performed to identify the isthmocele location and visualize the cavity post-embolization. The robotic platform was chosen as the mode of surgery. Entry into the retroperitoneum with transient occlusion of the uterine arteries is planned due to proximity of isthmocele to left uterine artery as seen on MRI. Once the pararectal space is entered the ureter is localized on the medial leaf of the broad ligament. The uterine artery is then isolated and skeletonized. This procedure is performed bilaterally. Vascular clamps are then placed on the uterine arteries at their respective origins. The bladder is also backfilled to aid in creation of a bladder flap given the history of c-section. With firefly technology, the borders of the isthmocele are identified. This area is resected, the residual copolymer is removed from the defect, and the hysterotomy is repaired in two layers using unidirectional barbed suture. At the conclusion of the case, the vascular clamps are removed and vascular supply is restored. <h3>Measurements and Main Results</h3> Isthmocele resection and repair was achieved with an estimated blood loss of 25mL. The patient's symptoms resolved. <h3>Conclusion</h3> Evaluation of pathology on pre-operative imaging can impact surgical approach. Transient occlusion of the uterine arteries can aid in repair of isthmocele with minimal blood loss.