Transcatheter arterial embolization with ethylene vinyl alcohol copolymer (Onyx) for the treatment of hemorrhage due to uterine arteriovenous malformations

Barral, Pierre-Antoine; Saeed-Kilani, M.; Tradi, Farouk; Dabadie, A.; Izaaryene, Jean; Soussan, J.; Bartoli, Jean-Michel; Vidal, Vincent

doi:10.1016/j.diii.2016.09.003

Cited by 32 publications

(24 citation statements)

References 21 publications

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“…Selective UAE is an effective treatment when there is persistent heavy bleeding or when conservative management fails. There are many reports on the safety and efficacy of UAE and the possibility of subsequent pregnancy after the procedure [18][19][20][21][22]. Balloon tamponade may be attempted before UAE to stop the bleeding and stabilize the patient [3].…”

Section: Uterine Arteriovenous Malformation/uterine Vascular Malformamentioning

confidence: 99%

Multimodality imaging in secondary postpartum or postabortion hemorrhage: retained products of conception and related conditions

et al. 2017

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Secondary postpartum hemorrhage (PPH) and postabortion hemorrhage are rare complications. Retained products of conception (RPOC) is among the most common causes of both secondary PPH and postabortion hemorrhage. Other less common causes of secondary PPH are uterine vascular abnormalities such as arteriovenous malformations and pseudoaneurysms. These are usually related to a history of a procedure such as dilation and curettage or cesarean delivery. Subinvolution of the placental site is an idiopathic cause of secondary PPH; this condition may be underrecognized and therefore could have a higher incidence than currently reported. Gestational trophoblastic disease is rare but commonly presents as secondary PPH and resembles RPOC in radiologic appearance. The first-line imaging modality for secondary PPH is ultrasound, but computed tomography and magnetic resonance imaging may be used if the ultrasound findings are indeterminate. Angiography is an important tool for the definitive diagnosis of uterine vascular abnormalities. Appropriate management requires radiologists to be familiar with the multimodality imaging features of secondary PPH or postabortion hemorrhage.

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Section: Uterine Arteriovenous Malformation/uterine Vascular Malformamentioning

confidence: 99%

Multimodality imaging in secondary postpartum or postabortion hemorrhage: retained products of conception and related conditions

et al. 2017

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“…Only one paper [ 2 ] recently reported Onyx as single agent for the treatment of uterine AVF; in the presented case, embolization with Onyx-18 resolved both the FAV and the concomitant pelvic varicocele after a single procedural session.…”

Section: Discussionmentioning

confidence: 95%

“…The correct diagnosis of uterine AVF is based on negative hCG test and imaging of abnormal uterine vascular network with tortuous and serpiginous vessels [ 2 ]. Clinically, these are symptomatic patients for menometrorrhagia: bleeding is intermittent and torrential due to the differential pressure gradient across arterial and venous systems [ 2 ]. Women are typically in childbearing age with a history of uterine trauma secondary to gynecological procedures [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Uterine Arteriovenous Fistula with Concomitant Pelvic Varicocele: Endovascular Embolization with Onyx-18®

Giurazza

Corvino

Paladini

et al. 2017

Case Reports in Vascular Medicine

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Uterine arteriovenous fistulas are rare and acquired causes of life-threatening vaginal bleeding. They usually present with intermittent menometrorrhagia in young patients in childbearing age with history of gynecological procedures on uterus. Traditional management is hysterectomy; endovascular embolization represents nowadays an alternative strategy for patients wishing to preserve fertility. Here, the endovascular approach to a 29-year-old woman affected by severe menometrorrhagia caused by a uterine arteriovenous fistula with a concomitant pelvic varicocele is reported; a bilateral uterine arteries embolization with Onyx-18 (ev3, Irvine, CA, USA) has successfully resolved the fistula with clinical success.

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“…This procedure is minimally invasive while it is highly effective in controlling acute hemorrhage, and unlike hysterectomy, it allows fertility preservation. The reported success rate ranges from 79% to 93% and some patients require two or more embolization to reach AVM remission (4,(10)(11)(12)(13)(14). Nonetheless, in some cases, AVM revascularization or neovascularization after UAE, which results in the recurrence of symptoms, can lead to the failure of UAE and thus necessitates further interventions.…”

Section: Discussionmentioning

confidence: 99%

A Fertility-Preserving Laparoscopic Management Combined With Hysteroscopy of Uterine Arteriovenous Malformation Followed by Uterine Arteries Embolization: A Case Report

Ouyang

Xia

Yang

et al. 2019

International Journal of Women’s Health and Reproduction Scienc

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Objectives: The current study presented a fertility-preserving laparoscopic approach combined with hysteroscopy for the treatment of a uterine arteriovenous malformation (AVM) after a failed uterine artery embolization (UAE). Case Presentation: The patient was diagnosed with acquired uterine AVM and underwent a UAE, followed with the recurrence of massive vaginal bleeding. The computed tomography angiography (CTA) demonstrated AVM neovascularization and the patient profoundly desired to preserve her fertility. Results: The patient underwent a laparoscopic surgery combined with hysteroscopy during which the supply vessels of the AVM were obliterated and a 3-month GnRHa regimen was prescribed accordingly. The follow-up CTA was performed at postoperative day 3 and month 5. Both of the obtained images indicated the remission of the AVM. Thus, the patient remained asymptomatic during a 18-month follow-up after the operation. Conclusions: In general, the laparoscopic obliteration of the supply vessels of the uterine AVM could provide an alternative to hysterectomy in patients whose embolization attempt failed and thus had a fertility-preserving desire.

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Transcatheter arterial embolization with ethylene vinyl alcohol copolymer (Onyx) for the treatment of hemorrhage due to uterine arteriovenous malformations

Abstract: In women with metrorrhagia due to AVM, arterial embolization with Onyx is effective and safe. Additional research is needed to confirm the possibility of future pregnancy after Onyx embolization.

Cited by 32 publications

References 21 publications

Multimodality imaging in secondary postpartum or postabortion hemorrhage: retained products of conception and related conditions

Multimodality imaging in secondary postpartum or postabortion hemorrhage: retained products of conception and related conditions

Uterine Arteriovenous Fistula with Concomitant Pelvic Varicocele: Endovascular Embolization with Onyx-18®

A Fertility-Preserving Laparoscopic Management Combined With Hysteroscopy of Uterine Arteriovenous Malformation Followed by Uterine Arteries Embolization: A Case Report

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