Conservative Treatment of Uterine Arteriovenous Fistula

Forssman, Lars; Lundberg, Jan M.; Scherstén, T

doi:10.3109/00016348209156958

Cited by 70 publications

(26 citation statements)

References 12 publications

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“…Duplex ultrasound 1 day later (f) revealed normalization of the uterine vasculature effective and less invasive than surgery, not only for the treatment of AUVM, but also for primary and secondary postpartum hemorrhage [13][14][15][16]. Transcatheter embolization of uterine arteries in the treatment of UVM was first described by Forssman et al [17], and several other case reports and small series showed a very high technical and clinical success rate. Badawy et al [18] reviewed all 25 cases published between 1982 and 1999 and found a success rate after one to two embolization procedures of 96% and a complication rate of 4%.…”

Section: Discussionmentioning

confidence: 96%

Acquired uterine vascular malformations: radiological and clinical outcome after transcatheter embolotherapy

et al. 2005

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The purpose of this retrospective study is to assess the radiological and clinical outcome of transcatheter embolization of acquired uterine vascular malformations in patients presenting with secondary postpartum or postabortion vaginal hemorrhage. In a cohort of 17 patients (mean age: 29.7 years; standard deviation: 4.23; range: 25-38 years) 18 embolization procedures were performed. Angiography demonstrated a uterine parenchymal hyperemia with normal drainage into the large pelvic veins ("low-flow uterine vascular malformation") in 83% (n=15) or a direct arteriovenous fistula ("high-flow uterine vascular malformation") in 17% (n=3). Clinically, in all patients the bleeding stopped after embolization but in 1 patient early recurrence of hemorrhage occurred and was treated by hysterectomy. Pathological analysis revealed a choriocarcinoma. During follow-up (mean time period: 18.8 months; range: 1-36 months) 6 patients became pregnant and delivered a healthy child. Transcatheter embolization of the uterine arteries, using microparticles, is safe and highly effective in the treatment of a bleeding acquired uterine vascular malformation. In case of clinical failure, an underlying neoplastic disease should be considered. Future pregnancy is still possible after embolization.

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Section: Discussionmentioning

confidence: 96%

Acquired uterine vascular malformations: radiological and clinical outcome after transcatheter embolotherapy

et al. 2005

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“…Procedimento conservador que melhor resultado tem alcançado é a embolização da artéria uterina 28 . A embolização da artéria uterina, cuja téc-nica está cristalizada 9,29,30 , representa alternativa à histerectomia, sendo boa opção para preservar a função reprodutiva nas pacientes acometidas por MAVU.…”

Section: Resultsunclassified

Malformação arteriovenosa uterina após doença trofoblástica gestacional

Belfort¹,

Braga²,

Freire³

2006

Rev. Bras. Ginecol. Obstet.

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Objetivo: investigar a presença e resultados de malformações vasculares uterinas (MAVU) após doença trofoblástica gestacional (DTG). Métodos: estudo retrospectivo com inclusão de casos diagnosticados entre 1987 e 2004; 2764 pacientes após DTG foram acompanhadas anualmente com ultra-sonografia transvaginal e Doppler colorido no Centro de Neoplasia Trofoblástica Gestacional da Santa Casa da Misericórdia (Rio de Janeiro, RJ, Brasil). Sete pacientes tiveram diagnóstico final de MAVU baseado em análise ultra-sonográfica -índice de pulsatilidade (IP), índice de resistência (IR) e velocidade sistólica máxima (VSM) -e achados de imagens de ressonância nuclear magnética (RNM). Dosagens negativas de β-hCG foram decisivas para estabelecer o diagnóstico diferencial com DTG recidivante. Resultados: a incidência de MAVU após DTG foi 0,2% (7/2764). Achados ultra-sonográficos de MAVU: IP médio de 0,44±0,058 (extremos: 0,38-0,52); IR médio de 0,36±0,072 (extremos: 0,29-0,50); VSM média de 64,6±23,99 cm/s (extremos: 37-96). A imagem de RNM revelou útero aumentado, miométrio heterogêneo, espaços vasculares tortuosos e vasos parametriais com ectasia. A apresentação clínica mais comum foi hemorragia transvaginal, presente em 52,7% (4/7) dos casos. Tratamento farmacológico com 150 mg de acetato de medroxiprogesterona foi empregado para controlar a hemorragia, após a estabilização hemodinâmica. Permanecem as pacientes em seguimento, assintomáticas até hoje. Duas pacientes engravidaram com MAVU, com gestações e partos exitosos. Conclusão: presente sangramento transvaginal em pacientes com β-hCG negativo e história de DTG, deve-se considerar a possibilidade de MAVU e solicitar avaliação ultrasonográfica com dopplervelocimetria. O tratamento conservador é a melhor opção na maioria dos casos de MAVU pós-DTG. PALAVRAS-CHAVE:Malformação arteriovenosas; Neoplasias trofoblásticas; Ultra-sonografia Doppler; Imagem por ressonância magnética; Complicações na gravidez ABSTRACT Purpose: to investigate the presence and outcome of uterinevascular malformations (UVAM) after gestational trophoblastic disease (GTD). Methods: retrospective study of 2764 patients with GTD diagnosed from 1987 to 2004. All patients were followed up annually at the "Santa Casa da Misericórdia" Trophoblastic Disease Center (Rio de Janeiro, RJ, Brazil) with transvaginal ultrasonography (US) and color Doppler imaging. Seven patients had a final diagnosis of UVAM based on ultrasonographic analysis -pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV) -and pelvic magnetic nuclear resonance (MNR) findings. Negative β-hCG values were of utmost importance to establish differential diagnosis with persistent GTD. Results: the incidence of UVAM after GTD was 0.2% (7/2764). US features of UVAM: PI mean 0.44±0,058 (extremes: 0.38-0.52); RI mean 0.36±0.072 (extremes: 0.29-0.50); PSV mean 64.6±23.99 cm/s (extremes: 37-96). MNR image showed a bulky uterus, myometrial inhomogeneity, serpiginous flow-related signal voids, and prominent parametrial vessels. The most com...

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“…Embolotherapy has subsequently been used to control hemorrhage or blunt the clinical consequences of arteriovenous (AV) malformations occurring in several anatomic sites [22,23] and for cervical pregnancies [24][25][26][27]. Recently, this technique has been adopted to treat bleeding uterine leiomyomas (uterine fibroids) [28,29].…”

Section: Discussionmentioning

confidence: 99%

Near‐fatal uterine hemorrhage during induction chemotherapy for acute myeloid leukemia: A case report of bilateral uterine artery embolization

2004

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Severe transfusion-dependent uterine hemorrhage is a relatively uncommon complication of induction chemotherapy for acute myeloid leukemia (AML). Even less common is the failure of systemic conjugated estrogens in this setting. We report a case of lifethreatening uterine hemorrhage in a 38-year-old woman in the setting of transfusionrefractory thrombocytopenia after completing induction chemotherapy for AML. She experienced dramatic breakthrough uterine hemorrhage despite multiple platelet transfusions, conjugated estrogens, recombinant factor VIIa, '-aminocaproic acid, and intracavitary thrombin-soaked gauze tamponade. At the point of near-exsanguination in the setting of hypotension, hematocrit of 14%, and a platelet count of 3,000/mL, she underwent bilateral uterine artery embolization which proved immediately successful. We review the literature and indications for this procedure in the oncologic patient care setting. Am.

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Conservative Treatment of Uterine Arteriovenous Fistula

Cited by 70 publications

References 12 publications

Acquired uterine vascular malformations: radiological and clinical outcome after transcatheter embolotherapy

Acquired uterine vascular malformations: radiological and clinical outcome after transcatheter embolotherapy

Malformação arteriovenosa uterina após doença trofoblástica gestacional

Near‐fatal uterine hemorrhage during induction chemotherapy for acute myeloid leukemia: A case report of bilateral uterine artery embolization

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