Uterine arteriovenous malformations (AVMs) are a rare, potentially life-threatening cause of abnormal uterine bleeding that can be acquired following uterine instrumentation. We herein report a case of acquired uterine AVM following dilatation and curettage (D&C) that was successfully treated with bilateral embolization using Gelfoam (Pfizer, New York, USA) pledgets.

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In particular, we will discuss different strategies for successful and stable access to tortuous gonadal arteries. We will also discuss various embolic materials (including cyanoacrylate, coils, and particles) along with considerations for choice of embolic agent. We also demonstrate management of gonadal arteriovenous fistulae as well as tumor related hemorrhage. Conclusions: Gonadal artery hemorrhage is a rare but potentially life-threatening clinical entity. Proper evaluation by preprocedure imaging, technical considerations, and embolic agent choice are key for successful and safe endovascular management of gonadal artery hemorrhage.