Uterine artery arteriovenous malformations (AVMs) are rare anomalies that may result in uterine hemorrhage. A 40-year-old G8P5126 woman presented with severe vaginal bleeding and an estimated 2000 mL of blood loss at home. Three weeks prior, she had a vaginal delivery of a term infant resulting in post-partum hemorrhage, with 2700 mL of blood loss. The patient had a history of ectopic pregnancy, placenta previa, and dilatation and curettage. Interventional radiology was consulted, and the patient underwent angiography of the internal iliac and uterine arteries revealing the presence of a uterine AVM, which was successfully embolized using a thick mixture of n-butyl cyanoacrylate and lipiodol. The patient experienced no further episodes of bleeding and was discharged within 24 hours. Recognition of typical symptoms and risk factors for uterine arteriovenous malformations can facilitate early diagnosis and appropriate treatment.
Effective revascularization of peripheral artery disease relies on periprocedural pharmacological regulation of the clotting cascade. Patient-specific factors such as cardiovascular risk factors, contraindications, and individual psychosocial factors must be considered when initiating post revascularization management. Management with anticoagulant and antiplatelet agents is discussed to guide the interventionalist on which therapy may be appropriate for their patient. While exact treatment may be institution and provider dependent, the interventionist must be familiar with the available classes of medications and how they can be prescribed in the postprocedural setting to improve cardiovascular outcomes.
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