Uterine Arteriovenous Malformation—A Rare Cause of Abnormal Uterine Bleeding

Abstract

Uterine arteriovenous malformation (AVM) is a rare condition with fewer than 100 cases reported in the literature1. Despite being rare, it is a life threatening condition. In most cases, it is diagnosed during a severe and acute hemorrhagic event. It has a diverse symptomatology. Clinical presentation varies from no symptom to various degree of menorrhagia with massive life threatening vaginal bleeding. Clinical suspicion is essential for a prompt diagnosis and treatment. This case report describes a 24year old woman who presented with recurrent episodes of severe vaginal bleeding for the last 3 years. Initial episode was after a curettege for incomplete abortion 3years back. Trans-abdominal and transvaginal Doppler ultrasound of the pelvis showed presence of numerous tortuous and engorged vessels throughout the myometrium and both adnexal regions. Bilateral uterine and ovarian artery ligation was performed with significant improvement of patient’s symptom.Bangladesh J Ob et Gynaecol, 2014; Vol. 29(1) : 49-53

Transcatheter arterial embolization for the management of persistent metrorrhagia secondary to uterine arteriovenous malformation

“…There are few reported cases in literature; Dubreuli and Loubat reported the first cases in 1926. It is more frequently present in women of reproductive age and more than 95% of the patients are of premenopausal age [1][2][3] . According to Mulliken and Glowacki, they are a structural anomaly, which leads to abnormal communication between arteries and veins, are characterized by high-pressure gradients that allow high blood flow through a nidus which is composed of multiple dysplastic vascular channels that can be of low and high flow.…”

“…High-flow AVMs can affect pelvic structures, visceral organs, or both. They can be congenital or acquired, in most cases, they are acquired secondary to pelvic surgery, curettage, intrauterine devices, gynecological tumors, trophoblastic disease, prolonged exposure to synthetic estrogens, or infectious processes 2,3 . It should be mentioned that uterine AVMs are closely related to pregnancy because the malformation appears when the venous sinuses are incorporated into the scar of the myometrium after the necrosis of the chorionic villi secondary to intrauterine procedures or changes related to pregnancy [3][4][5][6] .…”

“…Clinically, patients present with chronic anemia, sustained secondary hypotension, or even with low cardiac output syndrome. Few patients rarely experience abdominal pain, polyuria, dyspareunia, pulsatile mass, or heart failure [2][3][4]7 .…”

“…However, confirmation takes place by arteriography with digital subtraction. Conventionally, the definitive treatment was hysterectomy (HTA); however, the endovascular approach is currently preferred, being minimally invasive, with good results and preserving fertility [1][2][3] .…”