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Successful Transarterial Embolization of Uterine Arteriovenous Malformation: Report of Three Cases.

Chen LK, Yang BL, Chen KC, Tsai YL - Iran J Radiol (2016)

Bottom Line: We describe three childbearing-age females, who had abdominal pain and heavy vaginal bleeding, and were diagnosed as uterine AVM by color Doppler and angiography.The patients received successful superselective transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA).Three years after treatment, one of them was admitted to our hospital for vaginal delivery at 39 weeks of gestation, and the baby was healthy.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, National Taiwan University, Taipei, Taiwan.

ABSTRACT
Uterine arteriovenous malformations (AVMs) are relatively rare disorders that can cause life-threatening vaginal bleeding. We describe three childbearing-age females, who had abdominal pain and heavy vaginal bleeding, and were diagnosed as uterine AVM by color Doppler and angiography. The patients received successful superselective transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA). Three years after treatment, one of them was admitted to our hospital for vaginal delivery at 39 weeks of gestation, and the baby was healthy.

No MeSH data available.


Related in: MedlinePlus

A 25-year-old female with a history of dysmenorrhea and irregular duration and intervals of menstrual cycles who came to the emergency department with acute abdominal pain and heavy vaginal bleeding with blood clots. A, Transvaginal gray-scale ultrasonography of the uterus revealed multiple varying-sized hypo-echoic lesions. B, At the same plane, the color Doppler ultrasonography showed a hypervascular lesion with multidirectional turbulent flow (typical mosaic pattern), measuring 4.9 × 3.3 × 2.6 cm in size in the endometrium and myometrium of the uterine fundus. C, During angiography, the catheter was inserted from the right femoral artery and its tip was at the end of the abdominal aorta. Aortography showed the feeding artery from the branches of the right internal iliac artery and tortuous veins with rapid venous shunting. D, After right-uterine-artery embolization, there were still some collateral abnormal vessels formed on the left side. E, Finally, bilateral superselective embolization of the uterine arteries was done smoothly.
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fig23433: A 25-year-old female with a history of dysmenorrhea and irregular duration and intervals of menstrual cycles who came to the emergency department with acute abdominal pain and heavy vaginal bleeding with blood clots. A, Transvaginal gray-scale ultrasonography of the uterus revealed multiple varying-sized hypo-echoic lesions. B, At the same plane, the color Doppler ultrasonography showed a hypervascular lesion with multidirectional turbulent flow (typical mosaic pattern), measuring 4.9 × 3.3 × 2.6 cm in size in the endometrium and myometrium of the uterine fundus. C, During angiography, the catheter was inserted from the right femoral artery and its tip was at the end of the abdominal aorta. Aortography showed the feeding artery from the branches of the right internal iliac artery and tortuous veins with rapid venous shunting. D, After right-uterine-artery embolization, there were still some collateral abnormal vessels formed on the left side. E, Finally, bilateral superselective embolization of the uterine arteries was done smoothly.

Mentions: A 25-year-old female, gravida 10, para 0, artificial abortion 10 (G10P0AA10), had a history of dysmenorrhea with irregular duration and intervals of menstrual cycles. She had had no menses for two months before coming to the emergency department with the chief complaint of acute-onset abdominal pain and heavy vaginal bleeding with blood clots. She had neither dizziness nor shortness of breath. Her body temperature (BT) was 37.3°C, heart rate (HR) was 92 times/minute, respiration rate (RR) was 18 times/minute, and blood pressure (BP) was 100/60 mmHg. The pregnancy- enzyme immunoassay test was negative, and beta-HCG was 13.11 mIU/mL, which was in the normal range. In the emergency department, her serum hemoglobin dropped from 13.8 mg/dL to 11.9 mg/dL in 6 hours. The gray-scale ultrasonography revealed multiple varying-sized hypo-echoic lesions (Figure 1A). The color Doppler ultrasonography showed a hypervascular lesion, 4.9 × 3.3 × 2.6 cm with multidirectional turbulent flow (Figure 1B). On admission, the patient was scheduled for angiography and TAE. The angiography showed the feeding artery from the branches of the right internal iliac artery and tortuous veins with relatively early venous return (Figure 1C), which indicated the diagnosis of uterine AVM. Superselective TAE of the right uterine artery using N-butyl cyanoacrylate (NBCA) was performed at first. On checking the left uterine artery, the angiography showed that there were still a few abnormal collateral vessels (Figure 1D). Therefore, bilateral uterine artery embolization was performed (Figure 1E). After the interventional treatment, the patient had mild dull pain in the lower abdomen, which was most likely related to ischemia, and could be relieved by oral non-steroidal anti-inflammatory drugs (NSAIDs). There was no more vaginal bleeding during hospitalization, and she was discharged 2 days after interventional treatment. Forty days after TAE, her menstrual bleeding started, and the follow-up ultrasonography showed no abnormal flow.


Successful Transarterial Embolization of Uterine Arteriovenous Malformation: Report of Three Cases.

Chen LK, Yang BL, Chen KC, Tsai YL - Iran J Radiol (2016)

A 25-year-old female with a history of dysmenorrhea and irregular duration and intervals of menstrual cycles who came to the emergency department with acute abdominal pain and heavy vaginal bleeding with blood clots. A, Transvaginal gray-scale ultrasonography of the uterus revealed multiple varying-sized hypo-echoic lesions. B, At the same plane, the color Doppler ultrasonography showed a hypervascular lesion with multidirectional turbulent flow (typical mosaic pattern), measuring 4.9 × 3.3 × 2.6 cm in size in the endometrium and myometrium of the uterine fundus. C, During angiography, the catheter was inserted from the right femoral artery and its tip was at the end of the abdominal aorta. Aortography showed the feeding artery from the branches of the right internal iliac artery and tortuous veins with rapid venous shunting. D, After right-uterine-artery embolization, there were still some collateral abnormal vessels formed on the left side. E, Finally, bilateral superselective embolization of the uterine arteries was done smoothly.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835739&req=5

fig23433: A 25-year-old female with a history of dysmenorrhea and irregular duration and intervals of menstrual cycles who came to the emergency department with acute abdominal pain and heavy vaginal bleeding with blood clots. A, Transvaginal gray-scale ultrasonography of the uterus revealed multiple varying-sized hypo-echoic lesions. B, At the same plane, the color Doppler ultrasonography showed a hypervascular lesion with multidirectional turbulent flow (typical mosaic pattern), measuring 4.9 × 3.3 × 2.6 cm in size in the endometrium and myometrium of the uterine fundus. C, During angiography, the catheter was inserted from the right femoral artery and its tip was at the end of the abdominal aorta. Aortography showed the feeding artery from the branches of the right internal iliac artery and tortuous veins with rapid venous shunting. D, After right-uterine-artery embolization, there were still some collateral abnormal vessels formed on the left side. E, Finally, bilateral superselective embolization of the uterine arteries was done smoothly.
Mentions: A 25-year-old female, gravida 10, para 0, artificial abortion 10 (G10P0AA10), had a history of dysmenorrhea with irregular duration and intervals of menstrual cycles. She had had no menses for two months before coming to the emergency department with the chief complaint of acute-onset abdominal pain and heavy vaginal bleeding with blood clots. She had neither dizziness nor shortness of breath. Her body temperature (BT) was 37.3°C, heart rate (HR) was 92 times/minute, respiration rate (RR) was 18 times/minute, and blood pressure (BP) was 100/60 mmHg. The pregnancy- enzyme immunoassay test was negative, and beta-HCG was 13.11 mIU/mL, which was in the normal range. In the emergency department, her serum hemoglobin dropped from 13.8 mg/dL to 11.9 mg/dL in 6 hours. The gray-scale ultrasonography revealed multiple varying-sized hypo-echoic lesions (Figure 1A). The color Doppler ultrasonography showed a hypervascular lesion, 4.9 × 3.3 × 2.6 cm with multidirectional turbulent flow (Figure 1B). On admission, the patient was scheduled for angiography and TAE. The angiography showed the feeding artery from the branches of the right internal iliac artery and tortuous veins with relatively early venous return (Figure 1C), which indicated the diagnosis of uterine AVM. Superselective TAE of the right uterine artery using N-butyl cyanoacrylate (NBCA) was performed at first. On checking the left uterine artery, the angiography showed that there were still a few abnormal collateral vessels (Figure 1D). Therefore, bilateral uterine artery embolization was performed (Figure 1E). After the interventional treatment, the patient had mild dull pain in the lower abdomen, which was most likely related to ischemia, and could be relieved by oral non-steroidal anti-inflammatory drugs (NSAIDs). There was no more vaginal bleeding during hospitalization, and she was discharged 2 days after interventional treatment. Forty days after TAE, her menstrual bleeding started, and the follow-up ultrasonography showed no abnormal flow.

Bottom Line: We describe three childbearing-age females, who had abdominal pain and heavy vaginal bleeding, and were diagnosed as uterine AVM by color Doppler and angiography.The patients received successful superselective transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA).Three years after treatment, one of them was admitted to our hospital for vaginal delivery at 39 weeks of gestation, and the baby was healthy.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, National Taiwan University, Taipei, Taiwan.

ABSTRACT
Uterine arteriovenous malformations (AVMs) are relatively rare disorders that can cause life-threatening vaginal bleeding. We describe three childbearing-age females, who had abdominal pain and heavy vaginal bleeding, and were diagnosed as uterine AVM by color Doppler and angiography. The patients received successful superselective transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA). Three years after treatment, one of them was admitted to our hospital for vaginal delivery at 39 weeks of gestation, and the baby was healthy.

No MeSH data available.


Related in: MedlinePlus