Success of uterine artery embolization in the management of postabortal arteriovenous malformations

Sunil Kumar Juneja, Pooja S. Tandon, Gagandeep Kaur
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2020 · vol. 9(3) , pp. 981 · doi:10.18203/2320-1770.ijrcog20200860 · W3006867083
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This retrospective study evaluated uterine artery embolization in 23 patients with postabortal arteriovenous malformations, excluding those with endometriosis or adenomyosis, and found the procedure successfully improved heavy menstrual bleeding symptoms.

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This retrospective study evaluated the efficacy of uterine artery embolization in treating acquired arteriovenous malformations following abortion. The researchers analyzed twenty-three reproductive-age patients presenting with heavy menstrual bleeding who were diagnosed via CT angiography and subsequently treated with embolization, while explicitly excluding individuals with conditions such as endometriosis or adenomyosis. All participants demonstrated symptom improvement during a six-month follow-up period, indicating that this procedure effectively preserves uterine function compared to hysterectomy. Relevance to endometriosis: the paper explicitly excludes patients with endometriosis from its inclusion criteria, noting it only as a differential diagnosis rather than a focus of investigation.

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Abstract

Background: Uterine artery arteriovenous malformations are an abnormal and non-functional connection between the uterine arteries and veins. It may be congenital or acquired. AVM can cause heavy menstrual bleeding and may have an impact on infertility. Uterine artery embolization is an alternate method to hysterectomy preserving the menstrual and reproductive function. Objectives of this study was to diagnose Arterio-venous malformations after abortions in patients with heavy menstrual bleeding and treating these patients with UAE.Methods: The retrospective study of patients with postabortal arteriovenous malformations managed at Dayanand Medical College and Hospital, during January 2012 to December 2018 was done. Inclusion criteria for this study post abortal heavy menstrual bleeding patients in reproductive age group diagnosed to be having AV malformations on CT angiography. Exclusion criteria for this study were H/O AUB prior to abortion, patients with fibroids, PID, endometriosis, adenomyosis, genital tract malignancies. Patients who do not have AV malformations on CT angiography.Results: This is a retrospective seven years study between January 2012 to December 2018 during which we received 23 patients who developed arterio-venous fistula following an abortion. The patients had heavy menstrual bleeding. All the patients had taken some hormonal treatment before reporting to us. All these patients underwent CT angiography. After that they all were subjected to UAE. All these patients were followed up to 6 months where they showed improvement in the symptoms.Conclusions: Acquired AVM is rare disorder following an abortion or a caesarean section. Heavy menstrual bleeding is a common symptom often requiring hysterectomy but with the advent of uterine artery embolization by blocking the uterine artery we can conserve the uterus where a lady can have normal menstrual and reproductive functions.
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Background

Uterine artery arteriovenous malformations are an abnormal and non-functional connection between the uterine arteries and veins. It may be congenital or acquired. AVM can cause heavy menstrual bleeding and may have an impact on infertility. Uterine artery embolization is an alternate method to hysterectomy preserving the menstrual and reproductive function. Objectives of this study was to diagnose Arterio-venous malformations after abortions in patients with heavy menstrual bleeding and treating these patients with UAE.

Methods

The retrospective study of patients with postabortal arteriovenous malformations managed at Dayanand Medical College and Hospital, during January 2012 to December 2018 was done. Inclusion criteria for this study post abortal heavy menstrual bleeding patients in reproductive age group diagnosed to be having AV malformations on CT angiography. Exclusion criteria for this study were H/O AUB prior to abortion, patients with fibroids, PID, endometriosis, adenomyosis, genital tract malignancies. Patients who do not have AV malformations on CT angiography.

Results

This is a retrospective seven years study between January 2012 to December 2018 during which we received 23 patients who developed arterio-venous fistula following an abortion. The patients had heavy menstrual bleeding. All the patients had taken some hormonal treatment before reporting to us. All these patients underwent CT angiography. After that they all were subjected to UAE. All these patients were followed up to 6 months where they showed improvement in the symptoms.

Conclusions

Acquired AVM is rare disorder following an abortion or a caesarean section. Heavy menstrual bleeding is a common symptom often requiring hysterectomy but with the advent of uterine artery embolization by blocking the uterine artery we can conserve the uterus where a lady can have normal menstrual and reproductive functions. Metrics

References

Vilos AG, Vilos GA, Hollett-Caines J, Rajakumar C, Garvin G, Kozak R. Uterine artery embolization for uterine arteriovenous malformation in five women desiring fertility: pregnancy outcomes; Human Reprod. 2015;30(7):1599-605. Evans A, Gazaille RE, McKenzie R, Musser M, Lemming R, Curry J, et al. Acquired uterine arteriovenous fistula following dilatation and curettage: an uncommon cause of vaginal bleeding; Radiol Case Reports. 2017;12(2):287-91. Karadag B, Erol O, Ozdemir O, Uysal A, Alparslan AS, Gurses C, et al. Successful treatment of uterine arteriovenous malformation due to uterine trauma. Case Reports Obstet Gynecol. 2016:Article ID 1890650. Molvi SN, Dash K, Rastogi H, Khanna SB. Transcatheter embolization of uterine arteriovenous malformation: report of 2 cases and review of literature. J Minim Invasive Gynecol. 2011;18(6):812-9. Kohi MP, Spies JB. Update on uterine artery embolization. Semin Intervent Radiol. 2018;35(1):48-55. Annam A. Female pelvic vascular malformations. Semin Intervent Radio. 2018;35(1):62. Fleming H, Ostor AG, Picket H, Fortune AG. Arteriovenous malformations of the uterus. Obstet Gynecol. 1989;73-209-14. Cura M, Martinez N, Cura A, Dalsaso TJ, Elmerhi F. Arteriovenous malformations of the uterus. Acta Radiol. 2009;50(7);823-9. Grivell RM, Reid KM, Mellor A. Uterine arteriovenous malformations; a review of the current literature. Obstet Gynaecol Surv. 2005;60(11);61-7. Bonduki CE, Feldner PC, Silva JD, Castro RA, Sartori MG, Girao MJ. Pregnancy after uterine artery embolization. Clinics (Sao Paulo). 2011;66(5):807-10.

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endometriosisadenomyosisinfertility

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