Obstet Gynecol Sci.  2013 Sep;56(5):333-337.

Failed transarterial embolization of subserosal uterine arteriovenous malformation

• Seo KJ
• Kim J
• Sohn IS
• Kwon HS
• Park SW
• Hwang HS

Abstract

Uterine arteriovenous malformation (AVM) is rare but potentially life-threatening from excessive vaginal bleeding. All uterine AVMs reported to date have been found in the endometrial or myometrial layers. Here we present a patient with a subserosal type AVM on the fundus of uterus, which spontaneously ruptured.

Keyword

Arteriovenous malformation; Spontaneous rupture; Therapeutic embolization

MeSH Terms

Arteriovenous Malformations
Embolization, Therapeutic
Humans
Rupture, Spontaneous
Uterine Hemorrhage
Uterus

Figure

• 

  Fig. 1 Sagittal transvaginal gray-scale and color Doppler ultrasonographic images and pelvic angiography. (A) Multiple serpentine anechoic myometrial structures are showed by gray-scale image. (B) Multidirectional high-velocity vascular flow is demonstrated by color Doppler ultrasonographic scan. (C, D) About 1.7×1.7 cm sized anechoic round lesion with high velocity vascular flow (arrowhead) is noted on fundal area of uterus. (E) Abdominal aortogram shows enlarged bilateral uterine arteries and fundal arteriovenous malformation (AVM) (arrow). (F) Left ovarian angiography demonstrates additional supply to the AVM by enlarged, tortuous ovarian artery. (G) Postembolization aortogram for bilateral uterine arteries and left ovarian artery reveal no residual AVM flow.

• 

  Fig. 2 Magnetic resonance image of ruptured arteriovenous malformation (AVM), and macroscopic findings by emergency exploratory laparotomy. (A) Axial and (B) sagittal computed tomography scan images demonstrate rupture of cystic lesion on left fundal portion of uterus (arrowhead). Large amount hemoperitoneum is noted in abdominopelvic cavity. (C) About 3×3 cm sized subserosal type AVM is noted on fundus (arrow). (D) The ruptured AVM is removed, and repaired.

Reference

1. Grivell RM, Reid KM, Mellor A. Uterine arteriovenous malformations: a review of the current literature. Obstet Gynecol Surv. 2005; 60:761–767.

2. Lin AC, Hung YC, Huang LC, Chiu TH, Ho M. Successful treatment of uterine arteriovenous malformation with percutaneous embolization. Taiwan J Obstet Gynecol. 2007; 46:60–63.

3. Brown JV 3rd, Asrat T, Epstein HD, Oglevie S, Goldstein BH. Contemporary diagnosis and management of a uterine arteriovenous malformation. Obstet Gynecol. 2008; 112:467–470.

4. Timmerman D, Wauters J, Van Calenbergh S, Van Schoubroeck D, Maleux G, Van Den Bosch T, et al. Color Doppler imaging is a valuable tool for the diagnosis and management of uterine vascular malformations. Ultrasound Obstet Gynecol. 2003; 21:570–577.

5. Ginsberg NA, Hammer R, Parihk S, Tamura R, Sabbagha RE. Arteriovenous malformation of the uterus associated with a missed abortion. Ultrasound Obstet Gynecol. 1994; 4:235–237.

6. Halperin R, Schneider D, Maymon R, Peer A, Pansky M, Herman A. Arteriovenous malformation after uterine curettage: a report of 3 cases. J Reprod Med. 2007; 52:445–449.

7. Nicholson AA, Turnbull LW, Coady AM, Guthrie K. Diagnosis and management of uterine arterio-venous malformations. Clin Radiol. 1999; 54:265–269.

8. 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; 18:812–819.

9. Levy-Zaubermann Y, Capmas P, Legendre G, Fernandez H. Laparoscopic management of uterine arteriovenous malformation via occlusion of internal iliac arteries. J Minim Invasive Gynecol. 2012; 19:785–788.

10. Peitsidis P, Manolakos E, Tsekoura V, Kreienberg R, Schwentner L. Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review. Arch Gynecol Obstet. 2011; 284:1137–1151.

11. Kobayashi T, Yamazaki T, Takahashi M. Characteristic radiologic findings for cavernous hemangioma of the uterus. AJR Am J Roentgenol. 1999; 172:1147–1148.

12. Huang MW, Muradali D, Thurston WA, Burns PN, Wilson SR. Uterine arteriovenous malformations: gray-scale and Doppler US features with MR imaging correlation. Radiology. 1998; 206:115–123.

13. Fleming H, Ostor AG, Pickel H, Fortune DW. Arteriovenous malformations of the uterus. Obstet Gynecol. 1989; 73:209–214.