Uterine Arteriovenous Malformations (original) (raw)
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Uterine arteriovenous malformation — diagnosis and management
Ginekologia Polska, 2018
Uterine arteriovenous malformations are uncommon but potentially life-threatening conditions. They can be congenital or acquired and should be suspected in cases of severe or persistent uterine bleeding. In recent years, there has been an increasing number of reports of acquired vascular lesions of the uterus following pregnancy, abortion, caesarean delivery and curettage. This paper presents the review of the literature considered epidemiology, pathophysiology, diagnostic methods and treatment options. Unexplained uterine bleeding should be always an indication for colour Doppler ultrasonography and the presence of arteriovenous malformation should be always excluded.
Obstetrics and gynaecology cases - reviews, 2020
Uterine arteriovenous malformation (AVM) is defined as the rare occurrence of an abnormal and nonfunctional connection between uterine arteries and veins. Bleeding per vaginum is the typical presentation with potential for acute onset, life threatening haemorrhage. Investigations including ultrasound with or without doppler, magnetic resonance imaging [MRI] and angiography are often used to aid in the diagnosis. Management of uterine AVMs depend on the hemodynamic status of the patient, size and site of the lesion, severity of bleeding symptoms, age of the patient, desire for future fertility and treatment expertise available at hand. The therapeutic options available include medications like uterotonic and the combined contraceptive pill, balloon tamponade, surgical removal of the AVM, laparoscopic bipolar coagulation, uterine artery embolization and hysterectomy. The case we report is of a 27-year-old primigravida with acute onset vaginal bleeding, 3 weeks post ventouse delivery. She was resuscitated and investigated and subsequently had uterine artery embolization, prior to having a surgical evacuation of retained products of conception.
Uterine arteriovenous malformation: A rare yet perilous entity
INTERNATIONAL JOURNAL OF ENDORSING HEALTH SCIENCE RESEARCH (IJEHSR), 2021
Background: Uterine Arteriovenous Malformation (AVM) is a rare diagnosis. Although rare, it can cause massive and life-threatening hemorrhage, eventually leading to considerable morbidity and mortality. Healthcare professionals need to have a high index of suspicion in order to avoid the morbidity associated with Uterine Arteriovenous Malformation. We shed light on this relatively under-researched gynecologic diagnosis. Case Presentation: We describe the presentation, workup, including radiological studies, and subsequent management of Uterine Arteriovenous Malformation in two reproductive-age females who presented to our hospital with abnormal vaginal bleeding. Both patients had a history of primary hemorrhage after abortion, requiring blood transfusion. Both patients underwent Magnetic resonance imaging (MRI) and showed a tortuous serpentine tangle of mixed signals extending from the deep myometrium into the endometrium. Management & Results: Diagnosis of Uterine AVM was establish...
Uterine Arteriovenous malformation: A Review of current literatures
2016
Introduction Arteriovenous malformations (AVMs) are vascular channels composed of admixture of arteries and veins without intervening capillaries. These AVMs consist of numerous fragile low-resistant arteriovenous shunts. AVM can occur in any part of the body such as the brain, spleen, lung, kidney, liver, intercostals spaces, iris and spermatic cord. 1 In general, AVMs are most commonly congenital and genetic transmission patterns are unknown. 1 The uterus is involved less commonly by AVM. Uterine arteriovenous malformation (UAVM) is a rare condition that affects women of reproductive age and clinically presents with unexplained profuse bleeding par vagina. The bleeding is usually intermittent, torrential, or may be intractable and life threatening. UAVM are abnormal vascular channels that involve the myometrium and occasionally the endometrium. Myometrial involvement is more common than endometrial AVMs. Endometrial affectation is usually from extension of the myometrial UAVM. The...
Arteriovenous Malformation of the Uterus: A Review and Update
Obstetrics Gynecology and Reproductive Sciences, 2021
Arteriovenous malformation of the uterus (AVMU) is a very rare and uncommon condition, because it has been documented that less than 100 cases of AVMU have been reported in the literature. AVMU is potentially a life-threatening condition with regard to the fact that some cases of AVMU could manifest with profuse bleeding from the uterus via the vagina. AVMU could either be congenital AVMU which is less common or acquired AVMU with pregnancy noted to have a role to play in the pathogenesis of AVMUs. The true incidence of AVMU is stated to be difficult to ascertain in view of the fact that some cases of bleeding that have been caused by AVMU do tend to conservative, medical management and many of these AVMUs could remain undiagnosed. The most common manifestations of AVMUs tend to be abnormal uterine bleeding that could be episodic, intermittent, continuous, mild or torrential which could lead to severe anaemia or shock. Some AVMUs could be found incidentally based upon radiology imag...
Arteriovenous Malformation of the Uterus in a 41-Year-Old Woman Presenting as Uterine Bleeding
Cureus, 2022
An arteriovenous malformation (AVM) is a vascular lesion most frequently encountered in the brain, lungs, colon, and soft tissues of the extremities. However, rarely, an AVM may develop in the uterus, where it can cause abnormal and even life-threatening uterine bleeding. Here, we present the case of a 41-year-old G6P6 woman with abnormal uterine bleeding which resulted in a hemoglobin level of 10.2 g/dL. On gross examination, the uterus was enlarged measuring 17.5 cm x 12.0 cm x 10.0 cm, with a pronounced globoid appearance and bogginess on palpation. The cut surface was hemorrhagic and notable for numerous tortuous dilated spaces of variable sizes. These hemorrhagic, cavernous spaces were grossly apparent throughout the entire myometrium, but were found to be most prominent in the lower uterine segment of the anterior wall. Microscopic examination revealed an admixture of malformed vasculature comprising arteries, venules, and capillaries. The vessels showed prominent dilation and tortuosity with abrupt variation in the thickness of the media and elastic lamina, as highlighted by Von Gieson stain. Unlike in many other organ systems where AVMs are often considered congenital lesions, uterine AVMs are more often acquired lesions that develop following iatrogenic uterine trauma, namely cesarean section or curettage. Upon review of our patient's history, her final delivery was via cesarean section, after which she developed abnormal uterine bleeding. We present this case as a reminder to consider uterine AVM in cases of abnormal uterine bleeding, as it may be easily overlooked by even the most experienced pathologist.
Uterine Arteriovenous Malformation: A Near-Missed Fatal Misdiagnosis?
Borneo Journal of Medical Sciences (BJMS)
Less than 100 cases of uterine arteriovenous malformations (AVM) have been documented. The true incidence remains unknown with 30% complicated by hypovolemic shock. Women who experience unexplained vaginal bleeding may consider this diagnosis. We chose to emphasize this case because, while being a rare disease, it could cause mortality if misdiagnosed. In this case, a 23-year-old lady, para 1+2 with a history of several miscarriages and curettage, complained of per vaginal bleeding more than 2 months after her suction and curettage on September 2018. Her second visit was managed as having retained product of conception and another curettage was conducted. Despite this, the patient still has worsening vaginal bleeding which leads to her third visit. A bedside ultrasound was conducted and suspected uterine AVM. This was then further confirmed with contrast-enhanced computed tomography of the pelvis and pelvis angiography. Five Micronester coils and 10% Histoacryl adhesive were used to...
Uterine Arteriovenous Malformations: Therapeutic Strategies and the Place of Hysteroscopy
Open Journal of Obstetrics and Gynecology, 2021
Uterine arteriovenous malformations (UAVMs) are not common and are not well known. They are mainly manifested by hemorrhages that can be life-threatening. Their diagnosis is based mainly on ultrasound coupled with Doppler flow, as well as pelvic magnetic resonance imaging and angiography. In the absence of a consensus, and based on our experience, we discuss the place of hysteroscopy in the therapeutic strategy of UAVM. We reported 3 cases of UAVM, and we performed a review of the literature concerning the diagnosis and treatment of this pathology. We finally collected the advantages of the embolization-hysteroscopy sequence. In fact, the data suggest that hysteroscopy is a feasible and safe alternative treatment modality for UAVM. We believe that the resection of UAVM can be done under optimal conditions with a reduced risk of bleeding. Hysteroscopy would allow for optimal evaluation of the uterine cavity after treatment as well as the possibility of applying an anti-adhesive gel. In addition, the combination of hysteroscopy and embolization would require less healing time and shorter follow-up than embolization alone. It could also reduce the number of patients lost to follow-up.
A Case Series on Uterine Arteriovenous Malformations: A Life-Threatening Emergency in Young Women
Cureus, 2020
Uterine arteriovenous malformation (AVM) is a rare condition, with few cases reported in the literature. Despite being rare, it is a potentially life-threatening condition in women of child-bearing age. It should be considered in the differential diagnosis of prolonged or irregular vaginal bleeding, which, otherwise, can lead to critical complications ending up in severe morbidity and mortality. This case series describes four cases of young Asian women aged between 33 and 38 years who presented with irregular vaginal bleeding. Trans-abdominal ultrasound of the pelvis showed increased vascularity with multi-directional blood flow in the uterus. Magnetic resonance imaging (MRI) confirmed an arteriovenous malformation in all cases. All cases remained stable through the diagnostic journey. Embolization of the arteriovenous malformation was performed successfully in three cases and one case was managed conservatively on hormones. Later, two of them conceived within a year and had live births at term. The aim of reporting these cases is to share the common presentation of this condition and our experience in making the diagnosis and treatment of such patients. Although a few cases are reported world over, none was reported earlier from Pakistani Asian women.
American Journal of Perinatology Reports, 2015
Arteriovenous malformations (AVMs) can be found anywhere in the vascular system, including the uterus. 1 An acquired uterine AVM is a rare cause of life-threatening bleeding that may be the result of trauma, surgical intervention, or in the setting of a preexisting pathologic uterine process. Historically, treatment for uterine AVMs required hysterectomy 2 ; however, transcatheter vascular embolization (TCE) has provided an alternative treatment option for patients wishing to preserve fertility. Nevertheless, the method and approach of transcatheter treatment and the embolic agent utilized varies in the literature. In this systematic review, acquired uterine AVMs will be discussed in regards to (1) pathophysiology, (2) clinical presentation, (3) diagnostic strategies, (4) treatment approaches, and (5) postprocedural patient management.