Trans-arterial embolization of acquired uterine arteriovenous malformation after Cesarean section: A case series

Abstract

Background: Acquired uterine arteriovenous malformation (AVM) is a rare conditiondue to traumatic episodes in cesarean section. The patient can suffer from lifethreateninghemorrhage or recurrent vaginal bleeding. Establishing this diagnosis isdifficult, often misdiagnosed due to lack of information and number of cases. Trans-Arterial Embolization (TAE) procedure is rarely performed in our center. All of thecases were found with history of massive bleeding and diagnosed lately after recurrentbleeding history. Even though promising, one of our cases failed to be managed withTAE. It is important to diagnose early symptoms of AVM in order to prevent the lifethreatening event.Case presentation: In these case series, four cases of AVMs after cesarean procedureswill be reviewed. One could be diagnosed in less than a month but the other three tookseveral months. The symptom of vaginal bleeding might occur a few weeks after theprocedure is done, and most patients need transfusion and hospitalization. Three out offour patients were initially sent to the hospital in order to recover from shock condition,and one patient was sent for a diagnostic procedure. AVMs diagnostic was establishedwith ultrasound with or without angiography. Three of our cases were succeeded byperforming TAE procedure without further severe vaginal bleeding. One case failed tobe treated with embolization and had to proceed with hysterectomy.Conclusion: AVM should be considered early-on in patient with abnormal uterinebleeding and history of cesarean section. Embolization is still the first-choice treatmentof AVMs, otherwise definitive treatment is hysterectomy in a patient without fertilityneed, or impossible to perform TAE.

Uterine Arteriovenous Malformation Acquired after Cesarean Section: A Case Report

“…AVM must be part of the differential diagnosis as a possible cause of persistent bleeding in the puerperium, as well as placenta accreta. MRI is essential for differential diagnosis [1].…”

“…In the past, treatment for symptomatic acquired uterine AVM required hysterectomy [1]. However, endovascular treatment has provided an alternative and less invasive treatment option for patients wishing to preserve fertility [1] [5].…”

“…(2021) Uterine Arteriovenous Malformation Acquired after Cesarean Section: A Case Report. Open Journal of Obstetrics and Gynecology, 11, 1512-1516. https://doi.org/10.4236/ojog.2021.1111142 cesarean section [1]. This condition is predominantly related to various forms of iatrogenic trauma such as hysteroscopy, curettage and myomectomy; even normal vaginal delivery could be traumatic enough to cause AVM.…”

“…This condition is predominantly related to various forms of iatrogenic trauma such as hysteroscopy, curettage and myomectomy; even normal vaginal delivery could be traumatic enough to cause AVM. Endometrial carcinoma, cervical carcinoma and gestational trophoblastic disease could be other causes of AVM [1] [2]. The incidence and the prevalence are difficult to determine because it's often misdiagnosed with retained products of conception and placenta accreta [3].…”

“…The choice of treatment varies from hormonal treatment (estrogen and progesterone, oral contraceptive, and intrauterine contraceptive devices), open surgical or Transarterial Embolization (TAE). In the past, treatment for symptomatic acquired uterine AVM required hysterectomy [1]. However, endovascular treatment has provided an alternative and less invasive treatment option for patients wishing to preserve fertility [5].…”