Uterine Arteriovenous Malformations:Report Of3Cases And Review Of The Literature

Objective:Uterine arteriovenous malformation (AVM) is a rare but potentially life-threatening source of bleeding. Due to the low incidence, most studies are case reports. Lack of systematic understanding of this disease leads to misdiagnosis or missed diagnosis. The aim of the following paper is to summarize the clinical features, diagnosis and treatment of uterine AVM, and to raise awareness of the disease and improve the diagnosis and treatment.Methods:We analyzed retrospectively the clinical data of3cases treated in our hospital between2001and2015. Summary the pathogenesis, clinical features, diagnosis, treatment and prognosis of uterine AVM with review of the literature.Results:Of the3cases we report, two patients are of reproductive age, the other one is postmenopausal. All of them have a history of induced abortion. One had the abortion only once, one had two times of medication abortion and an operation for ectopic pregnancy, one had the abortion once, vaginal delivery twice, and curetage for hydatidiform mole once. Two patients were asymptomatic, both of them are suspected of having uterine AVM from imaging findings, of whom one was first diagnosed with uterine fibroids and the other one was pregnant. For the other patient, vaginal bleeding was the first symptom. Physical examination:all of the3patients had an enlarged uterus, with a palpation of parametrial mass in one of them, which was connected to the uterus, hard, no tenderness and mobilizable. Auxiliary examinations:all of the3patients underwent ultrasound scanning. The patient of the first case didn’t do any other imaging due to the lack of equipment, and the result of the ultrasound scanning combined with the operative findings helped make the diagnosis of uterine AVM. Both of the other two patients were performed by MRI, one of them also underwent uterine arteriography and was diagnosed with uterine AVM. The blood HCG value was high in one of the patients who’s pregnant, and was negative in the other two. Because of limited imaging techniques, the patient of the first case had the exploratory laparotomy and was diagnosed with uterine AVM. Considering the high risk of bleeding in hysterectomy, bilateral iliac artery ligation was did. The patient recovered well. Artificial abortion under the monitoring of ultrasound was performed on the patient of the second case according to her request. During the abortion, lesions of the uterine AVM was avoided and there was no massive hemorrhage. Ultrasound scaning after the abortion showed no residue in the uterine cavity. Because of the high risk of bleeding during direct hysterectomy and bilateral adnexectomy, the patient of the last case underwent bilateral uterine arterial embolization first. The material of coil was used to achieve permanent embolization in response to the family members’demands. Ultrasound scanning following the embolization indicated good effect of the embolization and the patient chose to get out of the hospital and to visit again3months later.Conclusion:Typical presentation of uterine AVM is sudden, massive vaginal bleeding. Many patients can be asymptomatic and are suspected of having uterine AVM by imaging scanning. A combination of medical history, clinical manefestation, lab tests and imaging findings must be used together to establish a diagnosis of uterine AVM. To achieve optimal management of uterine AVM, considerings should include severity of the illness and the patiens’s demands.