Uterine Arteriovenous Malformation: A Case Report and Review of the Literature

Abstract

Uterine arteriovenous malformation (AVM) is a rare is a rare cause of abnormal uterine bleeding, which may lead to profuse uterine bleeding. We present the case of a 23-year-old woman with an AVM that was successfully managed by laparoscopic ligation of the internal iliac arteries. This procedure did not adversely affect the fertility of the patient and she became pregnant 6 months after the procedure and gave birth by cesarean section at 38 weeks. She later gave birth by cesarean section 2 more times. It is an effective alternative to uterine artery embolization (UAE) in the management of uterine AVM.

Keywords

• treatment
• laparoscopic internal iliac artery ligation
• Uterine arteriovenous malformation

References

1. 1.Grivell RM, Reid KM, Mellor A. Uterine arteriovenous malformations: a review of current literature. Obstet Gynecol Surv. 2005;60: 761–767.
2. 2.Priyank Chatra. Iatrogenic uterine injury leading to uterine arteriovenous malformation Radiology Case reports 2021; 2146-50.
3. 3. Cura M, Martinez N, Cura A, Dalsaso TJ, Elmerhi F. Arteriovenous malformations of the uterus. Acta Radiol. 2009;50:823-9.
4. 4. Peitsidis P, Manolakos E, Tsekoura V, Kreienberg R, Schwentner L. Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review. Arch Gynecol Obstet. 2011;284:1137-51.
5. 5. Müngen E, Yergök YZ, Ertekin AA, Ergür AR, Uçmakli E, Aytaçlar S. Color Doppler sonographic features of uterine arteriovenous malformations: report of two cases. Ultrasound in Obstetrics & Gynecology 1997; 10: 215–219
6. 6. Nasu K, Fujisawa K, Yoshimatsu J, Miyakawa I. Uterine arteriovenous malformation: ultrasonographic, magnetic resonance and radiological findings. Gynecol Obstet Invest. 2002;53:191-4.
7. 7. Levy-Zaubermann Y1, Capmas P, Legendre G, Fernandez H. Laparoscopic management of uterine arteriovenous malformation via occlusion of internal iliac arteries. J Minim Invasive Gynecol. 2012;19:785-8.
8. 8. Touhami O, Gregoire J, Noel P, Trinh XB, Plante M.Uterine arteriovenous malformations following gestational trophoblastic neoplasia: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2014;181:54-9.

9. 9. Vilos AG, Vilos GA, Hollett-Caines J, Rajakumar C, Garvin G, Kozak R. Uterine artery embolization for uterine arteriovenous malformation in five women desiring fertility: pregnancy outcomes. Hum Reprod. 2015;30:1599-605.
10. 10. Hasegawa A, Sasaki H, Wada-Hiraike O, Osuga Y, Yano T, Usman SM, Akahane M, Kozuma S, Taketani Y. Uterine arteriovenous fistula treated with repetitive transcatheter embolization: case report. J Minim Invasive Gynecol. 2012;19:780-4.
11. 11. Corusic A, Barisic D, Lovric H, Despot A, Planinic P. Successful laparoscopic bipolar coagulation of a large arteriovenous malformation due to invasive trophoblastic disease: a case report. J Minim Invasive Gynecol. 2009;16:368- 71.
12. 12. Yokomine D, Yoshinaga M, Baba Y, Matsuo T, Iguro Y, Nakajo M, Douchi T. Successful management of uterine arteriovenous malformation by ligation of feeding artery after unsuccessful uterine artery embolization. J Obstet Gynaecol Res. 2009;35:183-8.
13. 13. Milingos D, Doumplis D, Sieunarine K. Uterine arteriovenous malformation: fertility-sparing surgery using unilateral ligation of uterine artery and ovarian ligament. Int J Gynecol Cancer. 2007;17:735–737.
14. 14. Chen SQ, Jiang HY, Li JB, Fan L, Liu MJ, Yao SZ. Treatment of uterine arteriovenous malformation by myometrial lesion resection combined with artery occlusion under laparoscopy: a case report and literature review. Eur J Obstet Gynecol Reprod Biol. 2013;169:172-6.
15. 15. Doumouchtsis SK, Nikolopoulos K, Talaulikar V, Krishna A, Arulkumaran S. Menstrual and fertility outcomes following the surgical management of postpartum haemorrhage: a systematic review. BJOG. 2014;121:382-8.
16. 16. Kishino M, Miyasaka N, Takeguchi Y, Ohashi I. Retrograde transvenous obliteration for uterine arteriovenous malformation. Obstet Gynecol. 2014;123:427-30.
17. 17. Ahmed Y, Davidson J, Azar N. Ultrasound-guided Transcutaneous Embolization of Uterine Arteriovenous Fistula Performed for Treatment of Symptomatic, Heavy Vaginal Bleeding: Case Report with Brief Review of Literature. Journal of Medical Ultrasound 2015;23:146-149.
18. 18. Oride A, Kanasaki H, Miyazaki K. Disappearance of a uterine arteriovenous malformation following long-term administration of oral norgestrel/ethinyl estradiol. Journal of Obstetrics and Gynaecology Research 2014;40: 1807– 1810.
19. 19. Rosa E Silva JC, de Aguiar FM, de Sá Rosa E Silva AC, Candido Dos Reis FJ, Poli Neto OB, Nogueira AA. Conservative management of large uterine arteriovenous malformation: case report. Fertil Steril. 2008 Dec;90(6):2406-7.
20. 20. Khatree MHD, Titiz H. Medical treatment of a uterine arteriovenous malformation. Aust N Z J Obstet Gynaecol 1999;39: 378–380.
21. 21. Morikawa M, Yamada T, Yamada H, Minakami H. Effect of gonadotropinreleasing hormone agonist on a uterine arteriovenous malformation. Obstet Gynecol. 2006;108:751-3.
22. 22. Nonaka T, Yahata T, Kashima K, Tanaka K. Resolution of uterine arteriovenous malformation and successful pregnancy after treatment with a gonadotropin-releasing hormone agonist. Obstet Gynecol. 2011;117:452-5.
23. 23. Takeuchi K, Yamada T, Iwasa M, Maruo T. Successful medical treatment with danazol after failed embolization of uterine arteriovenous malformation. Obstet Gynecol. 2003;102:843-4.
24. 24. Krishnaswamy P, Subbanna I, Sivasambu G, Thukral U. Gonadotropinreleasing hormone agonist and depot medroxyprogesterone acetate following uterine artery embolization in the management of uterine arteriovenous malformation. Proc Obstet Gynecol. 2014; 4:12