Arteriovenous Malformations of the Uterus: Long-Term Follow-Up

Abstract

Background/Aim: Arteriovenous malformations (AVMs) of the uterus have various clinical presentations. With the advancement of and accessibility to imaging, the diagnosis of the lesions in association with less severe clinical presentations is becoming more common. Contrary to cases with severe hemorrhage, the management of these cases is not clear. The purpose of this study was to describe our experience with diagnosis, management and long-term follow-up of cases with different clinical presentations of uterine AVMs. Methods: The clinical and sonographic presentations of 8 cases diagnosed between July 2000 and July 2003 in our medical center are described. Annual sonographic follow-up was performed for a period of at least 42 months. Results: Only 3 of the 8 cases presented with heavy vaginal bleeding and 2 of them required selective embolization. Two patients had hysterectomy during the study period which was not related to a severe bleeding event. Long-term follow-up for all other cases was significant for sonographic resolution of the uterine AVM. Conclusion: Management of uterine AVMs should be influenced by the clinical and not by the sonographic findings. If clinically feasible, conservative management should be considered as the primary approach, since most of these lesions tend to spontaneously resolve.

Treatment of uterine arteriovenous malformation by myometrial lesion resection combined with artery occlusion under laparoscopy: a case report and literature review

“…At present, numerous noninvasive diagnostic methods have been proposed to diagnose uterine AVM, such as contrastenhanced computed tomography (CT), MRI and color Doppler ultrasound [3][4][5][6][7]12,13]. With the development of spectral color Doppler ultrasonography, diagnosis of AVM has become easier.…”

“…Uterine packing with a Foley catheter has been reported to control acute blood loss successfully. Medical treatment includes combined oral contraceptives, methylergonovine, danazol and gonadotropin-releasing hormone (GnRH) agonists [4,13]. Surgical options can be used to manage uterine AVM.…”

“…Uterine AVM occurs more often in women of reproductive age. Its typical symptom is abnormal vaginal bleeding including massive vaginal bleeding and hypermenorrhea [3,4].…”

Retained Products of Conception

“…If bleeding is excessive, or if visualized vessels are of a substantial caliber, then dilation and curettage, if undertaken, should be performed with caution. [14][15][16] In our series, patients with type 3 vascularity were followed serially with sonography and either treated with uterotonics or dilation and curettage without complications.…”

Cas d’une hémorragie grave au cours d’une interruption volontaire de grossesse par aspiration : malformation artérioveineuse ou placenta accreta du premier trimestre ?

“…Toutefois, certains auteurs considéraient, avant l'utilisation de technique de radiologie interventionnelle, que la pré-sence d'une MAV était une contre-indication absolue à la grossesse, même si elle est asymptomatique [34]. Ainsi, la stratégie thérapeutique devrait être guidée par la clinique et non par les observations échographiques : dans certains cas, l'abstention thérapeutique peut être privilégiée, en considérant qu'une majorité de ces lésions décrites tendent à disparaître spontanément [35].…”