Resection of a Vulvar Arteriovenous Malformation in a Premenarchal Patient

Abstract

Arteriovenous malformations of the vulva require treatment before the onset of menarche because of the potential for massive hemorrhage. If first-line conservative treatment with embolization fails, a multidisciplinary team should be assembled for surgical treatment.

Arteriovenous Malformation of the Vulva

“…Occasionally, conservative measures fail and hemorrhage ensues, leading to surgical intervention [3,4]. Reports in the literature support surgical excision as being curative in most cases.…”

“…Although most vascular malformations are limited to the subcutaneous tissue, they may involve or be in proximity to surrounding muscles and neurovascular structures [3,4]. Hence, these imaging modalities are helpful in delineating the nature, depth, and extent of a vulvar lesion in relation to surrounding neurovascular structures, particularly when difficult surgical excision is anticipated [3,4].…”

“…Vascular malformations may be managed conservatively using vascular embolization or sclerotherapy, which involves injection of a sclerosing agent directly into the lesion [3,4]. Occasionally, conservative measures fail and hemorrhage ensues, leading to surgical intervention [3,4].…”

“…Arteriovenous malformations may occur as isolated entities, or as part of a syndrome such as Osler-Weber-Rendu syndrome [3]. In general, vascular lesions may be classified based on the main channel type, that is, arterial, venous, capillary, lymphatic, or mixed [4].…”

“…Table 1 summarizes all cases published in the medical literature associated with AVMs. Vascular malformations have also been described in other regions of the body, including the scalp, face, and neck, as well as intracranially [3]. Most AVMs are found incidentally, and the masses are frequently asymptomatic; some, however, present as a soft, palpable mass associated with pain and bleeding [1Y3].…”