Learning objectives
To understand the pathophysiology and describe the types of uterine Arteriovenous malformation.(AVM)
To describe the clinical presentation and associations of uterine AVM.
To learn the USG,
cross sectional and angiographic signs of uterine AVM.
To familiarize with the technique,
embolic agents and complications of uterine AVM embolization
Background
Uterine AVMs are uncommon,
representing around 2 % of all causes of genital and intraperitoneal hemorrhages.
(1) However,
since they can lead to profuse and potentially life-threatening hemorrhage they cannot be ignored.
(2)
Trans catheter embolization(TAE) of uterine AVM is being increasingly used as an alternate to surgery due to its minimally invasive nature and fertility sparing benefits.
(3)
Uterine AVMs represent an abnormal communication between uterine arterial branches and myometrial venous plexus without intervening capillary network.
[Fig. 1]
♦Pathophysiology and types:
Classification:
#Congenital Uterine...
Findings and procedure details
♦Technique of uterine AVM embolization: (6,
8,14)
Procedure is done under local anesthesia maintaining strict aseptic precautions.
Unilateral/bilateral femoral artery accessis taken followed by 4 or 5-French introducer sheath placement at each puncture site.
Bilateral punctures allow simultaneous angiography of both uterine arteries with subsequent overall radiation dose reduction.
A 5 F Uterine Artery Catheter and 0.032” Terumo glide wire combination is used to perform internal iliac artery angiogram on either side.
Alternatively,
4 F catheters like Simmons,
renal double curve or cobra may be...
Conclusion
Knowledge of uterine AVM despite its rarity is essential as it can present with potentially life-threatening hemorrhage.
The presentation may overlap with gestational trophoblastic disease,
retained products of conception and postpartum hemorrhage and therefore in any patient of reproductive age with bleeding and history of uterine instrumentation,
differential diagnosis of uterine AVM should be considered.
Although hysterectomy is a definitive treatment option,
the role of transcatheter embolization as an effective treatment alternative is emerging with a clinical success rate of greater than 90% in few...
References
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Cura M,
Martinez N,
Cura A,
Dalsaso TJ,
Elmerhi F.
Arteriovenous malformations of the uterus.
Acta Radiologica.
2009 Sep; 50(7):823-9.
2.
O'Brien P,
Neyastani A,
Buckley AR,
Chang SD,
Legiehn GM.
Uterine arteriovenous malformations: from diagnosis to treatment.
Journal of Ultrasound in Medicine.
2006 Nov;25(11):1387-92.
3.
Katimada Annaiah T,
Kodakkattil Sreenivasan S.
Uterine arteriovenous malformations: clinical implications.
The Obstetrician & Gynaecologist.
2015 Oct 1;17(4):243-50.
4.
Fleming H,
Östör AG,
Pickel H,
Fortune DW.
Arteriovenous malformations of the uterus.
Obstetrics & Gynecology.
1989 Feb 1;73(2):209-14....