Repeated pulmonary embolism with cardiac arrest after uterine artery embolization for uterine arteriovenous malformation: A case report and literature review

Objective

Uterine arteriovenous malformation (AVM) is an abnormal and nonfunctional communication between uterine arteries and veins, currently managed by uterine artery embolization (UAE). Pulmonary embolism (PE) is the most severe and life-threatening complication of this procedure.

Leiomyosarcoma after uterine artery embolization. A case report

BACKGROUND: Hysterectomy is the most common treatment for relieving symptoms attributable to uterine leiomyomas; however, alternatives to hysterectomy are becoming increasingly available. Uterine artery embolization is being used more frequently in this clinical setting. CASE: A leiomyosarcoma was diagnosed incidentally in a 51-year-old, nulliparous woman who underwent uterine artery embolization for symptomatic leiomyomata and subsequent total abdominal hysterectomy/bilateral salpingo-oophorectomy due to unsatisfactory results of the embolization procedure. CONCLUSION: While the occurrence of preoperatively undiagnosed uterine leiomyosarcomas among patients undergoing hysterectomies has been reported, there are no reports of unsuspected leiomyosarcomas after uterine artery embolization. Criteria for selection of patients for the procedure should consider the possibility of leiomyosarcoma. With the increasing popularity of uterine artery embolization, cases like this are likely to be encountered in the future.     

Pregnancy after medical management of a uterine arteriovenous malformation. A case report

BACKGROUND: The natural history of conservatively managed uterine arteriovenous malformations is largely unknown, and the risks associated with subsequent pregnancy and vaginal delivery have not been established. CASE: A multiparous woman with a previously reported history of uterine arteriovenous malformation was monitored throughout pregnancy and vaginal delivery. Serial ultrasound studies were performed prior to a successful induction of labor for severe preeclampsia at 34 weeks' gestation. CONCLUSION: To our knowledge, this is the first report of pregnancy and vaginal delivery in a woman with a prior history of a medically managed uterine arteriovenous malformation. Noninvasive treatment of uterine arteriovenous malformations is rare, and the potential long-term risks of this approach, including pregnancy, remain uncertain.     

Ectopic pregnancy after successful treatment with percutaneous transcatheter uterine arterial embolization for congenital uterine arteriovenous malformation: a case report

INTRODUCTION: Uterine arteriovenous malformation (AVM) is a rare disease. Percutaneous transcatheter uterine arterial embolization (UAE) has been performed in patients who wish to preserve their ability to conceive. UAE is considered to be a safe and effective procedure, but its long-term effect on fertility has not been fully elucidated. We present a case of ectopic tubal pregnancy after conservative treatment with UAE for uterine AVM. CASE: A 30-year-old Japanese woman was admitted for the treatment of unruptured right tubal pregnancy at 6 weeks of gestation. She had conceived spontaneously and delivered a healthy baby at term, 3 years previously. Subsequently, she was successfully treated with UAE for a large congenital uterine AVM. Transvaginal color Doppler ultrasonography revealed no evidence of residual AVM vessels. After the diagnosis of ectopic pregnancy, the patient underwent right tubectomy. At laparotomy, there were no adhesions or structural anomalies in the pelvic cavity that might affect tubal function. The patient's postoperative course was uneventful, and she is now healthy without conception 24 months after surgery. CONCLUSION: Prior uterine arterial embolization may have affected the tubal function in the present case, allowing tubal pregnancy to occur.     

Pregnancy after transcatheter embolization of a uterine arteriovenous malformation

A 25-year-old woman with a congenital uterine arteriovenous malformation had a long history of repeated excessive vaginal bleeding. She was successfully treated with transarterial embolization. She had normal menstrual periods for 6 months and subsequently conceived. She was delivered of a normally grown baby at 35 weeks. To the best of our knowledge, this is the third pregnancy described after successful embolization of an arteriovenous malformation.     

Prolapsed cervical myoma after uterine artery embolization. A case report

BACKGROUND: Cervical prolapse of myomas following uterine artery embolization is an infrequently reported occurrence. CASE: A 40-year-old woman with a history of three prior abdominal myomectomies underwent uterine artery embolization for severe menorrhagia due to myomas. Two weeks later a large cervical myoma prolapsed, requiring an abdominal hysterectomy. CONCLUSION: Cervical myomas should be considered a relative contraindication to uterine artery embolization.     

Pregnancy complicated by asymptomatic uterine arteriovenous malformation: a case report

BACKGROUND: Uterine arteriovenous malformation (AVM) is a rare disease. Percutaneous arterial embolization has been performed for patients who wish to preserve their ability to conceive. CASE: A 27-year-old primigravida was admitted for treatment of threatened premature labor at 21 weeks of gestation. She had been diagnosed with asymptomatic uterine AVM 2 years previously. She had not received any treatment before conception. At 41 weeks of gestation she spontaneously delivered a healthy infant weighting 3,154 g. and the Excessive bleeding (1,600 mL) occurred, probably due to eruption of the AVM vessel at the time of parturition. At 3 months postpartum, the patient underwent arterial embolization of AVM. CONCLUSION: The management of uterine AVM should be individualized, taking into account the patient's desire to maintain her fertility and the symptoms.     

Conservative management of large uterine arteriovenous malformation: case report

Uterine arteriovenous malformation is a rare condition that may be associated with uterine bleeding. Eventually morphologic aspects of the lesions induce unnecessary aggressive surgery; we report here a case of successful expectant management.     

Vesicouterine fistula after uterine artery embolization: a case report

Complications of uterine artery embolization (UAE) for treatment of leiomyoma uteri include contrast reactions, hematoma, postembolization syndrome, infection, pulmonary embolus, premature ovarian failure, and uterine necrosis. We present a case of vesicouterine fistula and extrusion of a degenerating leiomyoma into the bladder after UAE, necessitating hysterectomy and partial cystectomy for repair.     

Uterine artery malformation as a hidden cause of severe uterine bleeding. A case report

BACKGROUND: Uterine artery malformations are rare, life-threatening conditions. Clinical suspicion is essential for a prompt diagnosis and treatment. CASE: A 29-year-old woman was evaluated for severe uterine bleeding that started abruptly two weeks after elective termination of pregnancy. She underwent dilatation and curettage of the uterine cavity for retained products of conception. The patient presented to the emergency room two weeks later with abrupt onset of profuse vaginal bleeding that would spontaneously subside. Magnetic resonance angiography revealed a left uterine artery malformation that was successfully embolized. CONCLUSION: Uterine artery malformations should be suspected when heavy vaginal bleeding occurs in spite of medical or surgical treatment.     

Fertility and pregnancy outcomes following uterine artery embolization (UAE) for uterine arteriovenous malformation (AVM)

A 19-year-old patient presented with intractable uterine bleeding, 11 weeks post-abortion. A pelvic ultrasound with Doppler and color imaging suggested a uterine arteriovenous malformation. Failing conservative therapies, the patient consented to uterine artery embolization (UAE). Two months later, she conceived and had an uneventful normal vaginal delivery at term. Since this is an extremely rare condition, allowing limited clinical exposure and experience, there may be an underlying reluctance by general practitioners to treat these cases with uterine artery embolization for fear of compromising future fertility and pregnancies. However, data from the 20 pregnancies embolized for uterine AVM cited in the present report and data from embolization for uterine fibroids indicate that such fears may be unfounded since pregnancy rates and outcomes may not be compromised after UAE.     

Fertility outcomes following pelvic embolization in women with acquired uterine arteriovenous malformation

Objective

Acquired uterine arteriovenous malformation (UAVM) is a rare, life-threatening disease. Angiography with uterine arterial embolization (UAE) is the diagnostic tool and a choice of fertility-sparing treatment. Here, we present a series of five successful pregnancies after embolization of UAVM.

Successful medical treatment with danazol after failed embolization of uterine arteriovenous malformation

BACKGROUND: Transcatheter arterial embolization has been the therapy of choice for uterine arteriovenous malformations, whereas medical therapy has not been popular because of patient propensity to bleed. CASE: A 29-year-old woman, gravida 3, para 0, was diagnosed with uterine arteriovenous malformation. Because initial treatment with uterine artery embolization was unsuccessful, she was ultimately treated with danazol. Resolution of the lesion after 2 weeks of danazol therapy was observed. As of follow-up at 16 months, she has remained free from further abnormal bleeding episodes and recurrence of the lesion. CONCLUSION: Danazol has the potential for medical management of uterine arteriovenous malformations in hemodynamically stable patients who do not respond to embolization.     

Symptomatic arteriovenous malformation of Bartholin's gland. A case report

BACKGROUND: Arteriovenous malformations are composed of large, tortuous arteries and misshapen, veinlike structures. They are extremely uncommon in the genital tract. CASE: An arteriovenous malformation in a Bartholin gland presented as intermittent vaginal bleeding in a 43-year-old woman. CONCLUSION: Persistent unexplained bleeding from Bartholin's gland requires surgical excision.     

Transcatheter embolization of uterine arteriovenous malformation: report of 2 cases and review of literature

Arteriovenous malformation (AVM) of the uterus is a rare cause of menorrhagia and may at times lead to life-threatening hemorrhage. The clinical findings may not always be reliable in the diagnosis of uterine AVM, and a high index of suspicion is important because, unlike many other causes of menorrhagia, curettage may paradoxically aggravate the bleeding. Herein are described the cases of 2 patients with uterine AVM with abnormal vaginal bleeding. Both had a history of abortion followed by dilation and curettage. In both patients, the diagnosis of uterine AVM was established at Doppler flow ultrasonography. Treatment using transcatheter embolization was successful, and both patients had normal menstrual cycles at follow-up. One patient delivered a healthy baby 2? years after transcatheter embolization.     

Transvaginal uterine artery ligation in a woman with uterine leiomyomas. A case report

BACKGROUND: Uterine artery embolization by interventional radiologic techniques is an effective and widely used modality in the management of uterine leiomyomas. Anatomically, uterine arteries can be approached transvaginally with an appropriate surgical technique. In this report, we describe a novel, minimally invasive vaginal technique that also occluded the uterine arteries successfully. CASE: A 45-year-old woman with symptomatic leiomyomas decided to undergo a vaginal hysterectomy. During the procedure, Doppler ultrasonography demonstrated the cessation of blood flow after dissection and ligation of uterine arteries bilaterally without cutting the uterosacral and cardinal ligaments. CONCLUSION: Transvaginal ligation of the uterine arteries is possible. If validated by further clinical investigation, this minimally invasive gynecologic technique could be useful in selected cases of uterine leiomyomas.     

Treatment of uterine arteriovenous malformation by myometrial lesion resection combined with artery occlusion under laparoscopy: a case report and literature review

Uterine arteriovenous malformation (AVM) is an uncommon, potentially life-threatening condition, and the primary therapeutic method is embolization. We describe a case of a 36-year-old woman with acquired uterine AVM accompanied by abnormal vaginal bleeding. The diagnosis was established by Doppler flow ultrasonography combined with magnetic resonance arteriography. Because this uterine AVM was extensive and multiple, uterine arterial embolization could not be considered. We therefore employed a combined method under laparoscopy, in which the uterine arteries were first occluded, then uterine myometrial lesions were resected and abnormal pelvic blood vessels were ablated. Finally, the uterus was reconstructed with an intact uterine cavity. Abnormal vaginal bleeding was successfully stopped after operation, but amenorrhea due to uterine adhesions occurred. This method is suitable for the treatment of uterine AVM with extensive and multiple lesions, but it should be chosen cautiously for women of reproductive age with AVM and fertility requirement.     

Successful term pregnancy after selective embolization of a large postmolar uterine arteriovenous malformation

Abstract.   Tsai C-C, Cheng Y-F, Changchien C-C, Lin H. Successful term pregnancy after selective embolization of a large postmolar uterine arteriovenous malformation. Int J Gynecol Cancer 2006; 16(Suppl. 1): 339–341.
Uterine arteriovenous malformations (AVM) are very uncommon disorders. Successful conservative treatment with subsequently conceived is rarely reported. We describe a 31-year-old woman with a complex and large postmolar AVM; she was successfully treated with transarterial selective embolization for a long history of repeated excessive vaginal bleeding and anemia. She resumed normal menstrual periods soon after treatment, and she subsequently conceived about 2 years later. A healthy male baby was delivered at 39 weeks of gestation via vaginal route. Selective embolization of a complex and large uterine AVM seems to be feasible for the treatment of uterine bleeding and preservation of reproductive capability.