Hysteroscopic Management of Uterine Arteriovenous Malformation

Abstract

Background and Objectives:Uterine arteriovenous malformation (AVM) is characterized by shunts between the myometrial arteries and veins. Treatment is based on the severity of uterine bleeding and ranges from conservative medical approaches to embolization of affected arteries. The aim of study was to evaluate the feasibility and safety of hysteroscopy for management of uterine AVM.Methods:This was a retrospective study of a cohort of 11 cases occurring between March 2012 and December 2015 in our Regional Center of Excellence in Hysteroscopy, University of Florence. The diagnosis of AVM was made by transvaginal ultrasonography with high-definition flow in patients with mild to moderate symptoms. In all cases, we used the hysteroscopic platform Gynecare VersaPoint II (Ethicon, Somerville, New Jersey, USA), equipped with a 4-mm electrosurgical loop and associated with the SPIES (Storz Professional Image Enhancement System) system (Karl Storz, Tuttlingen, Germany).Results:All patients were successfully treated with operative hysteroscopy with no reported complications. No patient had residual disease detected by ultrasonography performed after a month. At this writing, of the 11 patients treated with operative hysteroscopy, 4 had achieved a pregnancy that carried to term, 1 was pregnant at 20 wk, and 1 had a miscarriage in the first trimester.Conclusions:Hysteroscopy is a feasible and safe alternative treatment modality for AVM. Patients treated with surgical hysteroscopy have high fertility outcomes, a 100% success rate after the first treatment, no complications related to the surgical procedure, and a short hospital stay.

Removal of retained products of conception showing marked vascularity without uterine artery embolization: Two case reports

“…We removed the retained products with marked vascularity without using UAE. Possible treatment options for RPOC are TCR or vacuum aspiration with a suction cannula . As previously reported, the evacuation procedure for RPOC with marked vascularity in the uterus might cause massive bleeding .…”

Successful management of abnormal uterine bleeding from uterine arteriovenous malformations with progesterone in postabortal patients

“…Emergency uterine artery embolization (UAE) is generally performed to stop the torrential bleed but is associated with significant risks of ovarian insufficiency and placental abnormalities during subsequent pregnancies . Hysteroscopic resection of AVM is the newest modality in the treatment of AVM . Being a minimally invasive procedure, patient needs admission, general anesthesia and costs involved with the procedure.…”

“…4,5 Hysteroscopic resection of AVM is the newest modality in the treatment of AVM. 6 Being a minimally invasive procedure, patient needs admission, general anesthesia and costs involved with the procedure. Moreover, it needs to be performed by trained persons in tertiary care referral centers.…”

A Rare Case of an Arteriovenous Malformation Scar Pregnancy Treated With a Combined and Conservative Approach

“…Medical treatment with gonadotropin‐releasing hormone agonists, danazol, or methylergonovine maleate allows the preservation of the patient's fertility, but this option is often not effective . Uterine artery embolization and iliac/uterine artery ligation are effective treatments, which are able to preserve the patient's fertility; among these options, laparotomic and laparoscopic surgeries are affected by major risks, supporting the validity of UAE …”

“…Among the several options, hysteroscopic surgery is suggested as a valid treatment of a uterine AVM, thanks to its ability to preserve the patient's fertility with a high success rate and no related complications . This evidence can be supported in selected cases of stable patients and moderate vascularization of the AVM, with a low risk of heavy bleeding.…”