Embolization of a uterine arteriovenous malformation followed by a twin pregnancy

BACKGROUND: Uterine arteriovenous malformation is a lesion that can cause recurrent pregnancy loss. Very few successful pregnancies have been reported after selective embolization of an arteriovenous malformation. CASE: A 42-year-old gravida 6 para 0 with a history of four first-trimester spontaneous abortions was found to have a uterine arteriovenous malformation by hysterosalpingogram, which was confirmed by magnetic resonance angiography. She underwent selective transcatheter embolization of the arteriovenous malformation. A twin gestation was later conceived via in vitro fertilization. The twins were delivered by cesarean at term. CONCLUSION: Uterine arteriovenous malformation can be successfully treated with selective embolization, with good obstetric outcome.     

Uterine arteriovenous malformation. A rare cause of recurrent metrorrhagia

Uterine arteriovenous malformation is a rare condition. We report a case with acquired arteriovenous malformation arising from the left uterine artery. She was diagnosed by color Doppler ultrasound and treated with a selective uterine artery embolization.     

Forceps delivery after molar malignancy in a woman with arteriovenous malformation. A case report.

BACKGROUND: An arteriovenous (AV) fistula in the female pelvis is a rare finding. This report describes a successful pregnancy after selective embolization of a postmolar vascular malformation. CASE: At 5 weeks of pregnancy, a 27-year-old, white female, gravida 3, para 0, was discovered on ultrasound examination to have an AV malformation along with a fetal pole. The patient was asymptomatic and had previously received two courses of chemotherapy for a previous nonmetastasized malignant molar pregnancy. Doppler ultrasonography uncovered a vascular malformation extending from the margin of the fetal pole to the margin of the uterus. The pregnancy ended at 8 weeks with a spontaneous abortion. The patient underwent angiography and embolization of extensive right-sided uterine vessels. She resumed normal menstrual periods six weeks after the embolization and became pregnant. The pregnancy concluded in low forceps vaginal delivery of a healthy, female infant at 34 weeks. CONCLUSION: Vaginal delivery following postmolar pregnancy and a uterine AV malformation may be considered a viable delivery option.     

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.     

Treating a recurrent uterine arteriovenous malformation with uterine artery embolization. A case report

BACKGROUND: Uterine arteriovenous malformation is a rare condition. Uterine artery embolization offers the possibility of conservative management as opposed to the traditional hysterectomy. We report a case with recurrent uterine arteriovenous malformation confirmed by angiography and successfully treated with a second embolization procedure. CASE: A 33-year-old woman presented with heavy vaginal bleeding. The diagnosis of uterine arteriovenous malformation was suspected on Doppler ultrasonography and confirmed by angiography. The first embolization procedure was performed using polyvinyl alcohol and steel coils. Recurrence was diagnosed 1 year later with the same imaging techniques. The second embolization procedure was performed using histoacryl. The patient remained asymptomatic at 1-year of follow-up. CONCLUSION: Minimally invasive management is an option in recurrent uterine arteriovenous malformation.     

Embolization of uterine arteriovenous malformation for treatment of menorrhagia

Background  Uterine arteriovenous malformations are rare but potentially life-threatening conditions that should be suspected in unexplained severe vaginal bleeding. Case  A 28-year-old gravida 7, para 3 presented to the emergency department with heavy vaginal bleeding and passage of blood clots. In the emergency room, her hemoglobin dropped from 11.2 to 7.4 gm%. Transvaginal ultrasonographic scan showed a large vascular mass in the uterus measuring 2.6 cm in diameter with low resistance of flow within, concerning for arteriovenous malformation or an arteriovenous fistula. Digital subtraction arteriography confirmed the lesion. She underwent angiography and bilateral uterine artery embolization. Conclusion  The diagnosis of uterine arteriovenous malformation requires a high index of suspicion in the scenario of unexplained severe vaginal bleeding. Digital subtraction angiography is the gold standard for definitive diagnosis and allows immediate treatment by embolization.     

Chronic pelvic pain: a rare complication following a large-loop excision of the transformation zone

This is the unique report of a patient with deep-seated, left-sided pelvic pain following a large-loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia III. She transpired to have a definite diagnosis of pelvic varicosities which were only on the left side. Our surmise was that the varicosities had risen on the back of an arteriovenous malformation following her LLETZ performed by a colleague. The first attempted treatment was radiologic embolization. When this failed, she had a formal surgical procedure, and the left unilateral varicosities were ligated. Her pain ceased entirely thereafter, and she remained pain free at her 1-year review.     

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.     

Congenital hepatic arteriovenous malformation: an unusual cause of neonatal persistent pulmonary hypertension.

Congenital hepatic arteriovenous malformations are rare anomalies, which typically present in infancy with congestive heart failure, anemia, and hepatomegaly. Morbidity and mortality is high if the condition is not recognized and treated promptly. Hepatic arteriovenous malformation associated with persistent pulmonary hypertension of the newborn has been reported in two cases in the literature. We report a neonate who was referred for management of persistent pulmonary hypertension and was subsequently diagnosed with a large hepatic arteriovenous malformation. He underwent coil embolization following which pulmonary hypertension resolved.     

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.     

Uterine arteriovenous malformation successfully embolized with a liquid polymer, isobutyl 2-cyanoacrylate

A uterine arteriovenous malformation was diagnosed angiographically in a 27-year-old woman presenting with recurrent menometrorrhagia. Bilateral hypogastric artery embolization with a liquid polymer, isobutyl 2-cyanoacrylate (Bucrylate), resulted in subsequent normal menses. Bucrylate offers a number of advantages over other agents previously used to embolize uterine arteriovenous malformations.     

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.     

A new fertility-preserving treatment modality for life-threatening bleeding caused by acquired uterine arteriovenous malformation (AVM): Combination laparoscopic ligation of uterine arteries and AVM suture

ObjectiveSymptomatic Uterine arteriovenous malformation (AVM) can result in sudden and massive vaginal bleeding that can be life-threatening. We report a new fertility-preserving treatment modality for disastrous bleeding caused by acquired uterine AVM: Combination laparoscopic ligation of uterine arteries and AVM suture.Case reportA 39-year-old female received Dilatation and Curettage due to missed abortion. However, she experienced heavy vaginal bleeding after surgery. Uterine arteriovenous malformation (AVM) was diagnosed by color Doppler ultrasonography, hysteroscopy, and angiography. She was successfully treated using laparoscopy bilateral uterine arteries ligation followed by application of uterine AVM suture with absorbable barbed wound closure device. After the laparoscopic surgery, vaginal bleeding stopped immediately. Complete regression of the AVM lesion on sonography was noted 8 months after laparoscopic surgery. Besides, this patient had normal menstruation after the operation.ConclusionThis case report describes for the first time a successful combination of bilateral uterine artery ligation and AVM suture to treat a patient with uterine arteriovenous malformation. We demonstrated the efficacy and safety of this fertility preserving method.     

Vulval low-flow arteriovenous malformation

This case report refers to a 26-year-old woman who attended a gynaecological clinic with a painful vulval swelling. She underwent surgical excision, was found to have a rare vulval low-flow arteriovenous malformation and was treated with embolisation therapy.     

Arteriovenous malformation after uterine curettage: a report of 3 cases

BACKGROUND: Acquired uterine arteriovenous malformation is a rare but potentially life threatening condition and, as such, must be considered in the differential diagnosis of cases of abrupt, profuse vaginal bleeding following uterine curettage. The condition can easily be confused with retained products of conception and gestational trophoblastic disease. CASES: One case was managed surgically, while 2 others were treated with selective embolization. CONCLUSION: A positive medical history, the clinical presentation and features for the the ultrasonic appearance are the main features for the correct differential diagnosis and treatment of traumatic arteriovenous malformation resulting from uterine curettage.     

Amenorrhoea revealing an arteriovenous uterine malformation, and recovery of menses after embolization

A case is reported of secondary amenorrhoea related to an arteriovenous malformation (AVM) successfully treated with embolization, with a recovery of menstrual cycles. A 28-year-old woman presented with secondary amenorrhoea as the only clinical symptom. Although she had an eugonadic status, there was no genital withdrawal bleeding upon cessation of an oral contraceptive. Pelvic transvaginal ultrasonography revealed a pelvic mass but magnetic resonance imaging (MRI) clearly showed an AVM. Classical angiography was performed with endovascular embolization. Partial thrombosis of the lesion was assessed by magnetic resonance angiography. Recovery of menses occurred 2 months later. It is speculated that blood stolen from the endometrium by the uterine AVM could have been responsible for the amenorrhoea. It is a very unusual cause, and it can be successfully treated with embolization.     

Conservative management of cerebellar hemorrhage in pregnancy

A case of cerebellar arteriovenous malformation (AVM) during pregnancy is reported. A 26-year-old primigravida had cerebellar hemorrhage at 32 weeks of gestation. She was conservatively controlled until term with a good outcome accomplished by elective cesarean section. AVM in the left cerebellar hemisphere was confirmed by angiography after delivery and successfully removed. Here we present a review of AVM during pregnancy and a few case reports of cerebellar AVM-complicated pregnancy published in available literatures.     

Hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformations

Background: Most congenital pulmonary arteriovenous malformations are associated with hereditary hemorrhagic telangiectasia. During pregnancy, pulmonary hemorrhage can occur, compromising maternal and fetal health.Cases: We studied three pregnancies in two women with hemorrhagic telangiectasia complicated by pulmonary arteriovenous malformations. A 28-year-old primigravida’s fetus died at 25 weeks’ gestation, and she had embolotherapy with coil springs, which corrected the hypoxemic state. In a subsequent pregnancy she delivered a healthy 2315-g infant at 38 weeks’ gestation. A 19-year-old primigravida had spontaneous hemothorax at 26 weeks’ gestation with severe hypoxemia and a growth-restricted fetus without umbilical artery diastolic flow. Pulmonary arteriovenous malformation was diagnosed by computed tomography of the maternal lung. She had continued pulmonary bleeding, so emergency lung lobectomy was done. Maternal hypoxemia and umbilical diastolic flow improved, and she had term delivery of a healthy 2250-g infant.Conclusion: Antenatal diagnosis and treatment of women with hereditary hemorrhagic telangectasia and pulmonary arteriovenous malformations might prevent potentially life-threatening fetomaternal complications.     

Delivery by cesarean section after embolization for vaginal arteriovenous malformation

Vaginal arteriovenous malformation (AVM) can lead to life-threatening complications on delivery. No deliveries have been reported after selective embolization for a vaginal AVM. A 34-year-old nulliparous woman was found to have an arterial pulsatile mass on the left vaginal wall. The findings of magnetic resonance imaging and magnetic resonance angiography were consistent with an AVM. Selective transcatheter embolization for the AVM was done and, afterwards, the patient was found to be pregnant. The prenatal course was uneventful and the patient underwent elective cesarean delivery at term. Vaginal AVM can be successfully treated with selective embolization, with a good obstetric outcome.     

Fístulas arteriovenosas uterinas tras legrado. Manejo histeroscópico

Uterine arteriovenous malformations are uncommon entities that may lead to life-threatening genital bleeding. These malformations can be congenital or acquired. In this article, we review uterine arteriovenous malformations occurring after curettage, their incidence, and their hysteroscopic management. To our knowledge, the distinct therapeutic options are limited to expectant management with or without methylergometrine maleate, embolization and hysterectomy, without considering hysteroscopy. We believe that hysteroscopic management could be a new treatment option for uterine arteriovenous malformation occurring after curettage.