Title: Role of Uterine Artery Ligation in Arteriovenous Malformation
Author: Poonam Chandora
DOI: https://dx.doi.org/10.18535/jmscr/v11i12.26
Abstract
Introduction: Uterine AV malformation is a rare and under diagnosed cause of hemorrhage after diagnostic or therapeutic curettage, which can present with varying grades of severity. It is a potentially life-threatening condition, and diagnosis requires a high degree of suspicion on the part of the caregiver—and prompt diagnosis could save many a uterus and thus preserve fertility, due to the availability of conservative alternatives to hysterectomy.
Case: In our institution in 2023, case of symptomatic uterine AVMs has been reported of reproductive age group presenting with a history of miscarriage or termination of pregnancy for which curettage was done. The presentation was of torrential bleeding, and not controllable with regular measures. Diagnosis was by ultrasound color Doppler, and contrast MRI pelvis. The time interval between the onset of symptoms and the primary curettage was 55 days; patient underwent for bilateral uterine artery ligation followed by dilatation and curettage. On follow-up, patient’s is presently free of symptoms with no excessive bleeding or post op complications. Patient discharged in good condition.
Conclusion: Uterine AV malformation should be thought of as a differential diagnosis in all cases presenting with bleeding after miscarriage or curettage, since diagnosis is simple and treatment by selective artery ligation saves morbidity and more importantly reduces hospital stay and the absence from work.
Keywords: Arteriovenous malformation, uterine artery ligation, vascular malformations.
References
- Peitsidis, P., Manolakos, E., Tsekoura, V., Kreienberg, R., & Schwentner, L. (2011). Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review. Archives of gynecology and obstetrics, 284(5), 1137–1151. https://doi.org/10.1007/s00404-011-2067-7
- Timmerman, D., Wauters, J., Van Calenbergh, S., Van Schoubroeck, D., Maleux, G., Van Den Bosch, T., & Spitz, B. (2003). Color Doppler imaging is a valuable tool for the diagnosis and management of uterine vascular malformations. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 21(6), 570–577. https://doi.org/10.1002/uog.159
- Ghi, T., Giunchi, S., Rossi, C., Pilu, G., Savelli, L., Mollo, F., & Pelusi, G. (2005). Three-dimensional power Doppler sonography in the diagnosis of arteriovenous malformation of the uterus. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 24(5), 727–731. https://doi.org/10.7863/jum.2005.24.5.72.
- Vogelzang, R. L., Nemcek, A. A., Jr, Skrtic, Z., Gorrell, J., & Lurain, J. R. (1991). Uterine arteriovenous malformations: primary treatment with therapeutic embolization. Journal of vascular and interventional radiology: JVIR, 2(4), 517–522. https://doi.org/10.1016/s1051-0443(91)72234-3
- Grivell, R. M., Reid, K. M., & Mellor, A. (2005). Uterine arteriovenous malformations: a review of the current literature. Obstetrical & gynaecological survey, 60(11), 761-767.
- Brown, J. V., 3rd, Asrat, T., Epstein, H. D., Oglevie, S., & Goldstein, B. H. (2008). Contemporary diagnosis and management of a uterine arteriovenous malformation. Obstetrics and gynecology, 112(2 Pt 2), 467–470. https://doi.org/10.1097/AOG.0b013e3181719f7d
- Gopal, M., Goldberg, J., Klein, T. A., & Fossum, G. T. (2003). Embolization of a uterine arteriovenous malformation followed by a twin pregnancy. Obstetrics and gynecology, 102(4), 696–698. https://doi.org/10.1016/s0029-7844(03)00714-2
- O'Brien, P., Neyastani, A., Buckley, A. R., Chang, S. D., & Legiehn, G. M. (2006). Uterine arteriovenous malformations: from diagnosis to treatment. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 25(11), 1387–1395. https://doi.org/10.7863/jum.2006.25.11.1387