UTERINE ARTERIOVENOUS MALFORMATIONS – DIAGNOSIS AND TREATMENT IN SERIES OF CASES

Mariana Tsankova; Ivan Kostov; Ivo Petrov

doi:10.35120/medisij030317t

Authors

Mariana Tsankova University hospital of obstetrics and gynecology “Maichin Dom” Department, Medical University, Bulgaria
Ivan Kostov University hospital of obstetrics and gynecology “Maichin Dom” Department, Medical University, Bulgaria
Ivo Petrov University hospital of obstetrics and gynecology “Maichin Dom” Department, Medical University, Bulgaria

DOI:

https://doi.org/10.35120/medisij030317t

Keywords:

Uterine arteriovenous malformations, embolization of uterine arteries, hemorrhagic shock, endovascular treatment

Abstract

Uterine arteriovenous malformation (UAVM) is a rare but potentially life-threatening diagnosis. Misdiagnosed and inappropriately treated Uterine arteriovenous malformation can lead to excessive hemorrhage because of specific conditions: abnormal direct multiple fistulous communication between an artery and vein without an intervening capillary bed. This makes a high-pressure gradient into venous system, enlargement of some venous vessels and multidirectional high velocity blood flow. There are different treatment options, one of which is embolization of uterine arteries.The aim of this study is to present the etiology, clinical presentation, diagnostic options and therapeutic approaches to patients with Uterine arteriovenous malformation.This study is a prospective follow-up of series of cases with Uterine arteriovenous malformation, which have different etiology and different uterine localization - cervical and corporal.Our diagnostic method is ultrasonography – transvaginal, using both 2D grayscale, Color Doppler and Pulsed Wave Doppler. The machines used in this study are Samsung Hera and Medison.We present four cases of arteriovenous malformation (one of them congenital and three others: after normal delivery, after caesarean section; dilatation and curettage were executed for all of them). All the cases resulted in hemorrhagic shock and were successfully treated later with uterine artery embolization.Our study presents to the auditory unique cases initially misdiagnosed and mistreated with uterine curettage. They were correctly diagnosed later by ultrasonography and treated successfully through selective embolization of the feeding vessels. The research represents our personal experience in diagnosis and treatment of that life threatening condition and all cases were well illustrated with sonographic images, Color Doppler technic and embolization technics.A good therapeutic outcome is a result of obtained collaboration between a gynecologist, an expert sonographer and an invasive cardiologist.Uterine arteriovenous malformation can be safely and effectively treated with uterine artery embolization with even high chances of preserving women’s childbearing function.

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