Uterine Arteriovenous Fistulas Caused By GTN With Chemotherapy:Report Of 11 Cases And A Review Of The Literature

ObjectiveThe aim of following paper is to summarize the clinical features,treatment and fertility outcome of uterin AVM caused by gestational trophoblastic neoplasms with chemotherapy,and to provide more basis for treatment decisions.MethodsI analyzed the 11 cases treated in Qilu hospitai between 2006 to 2016.All AVM patients caused by GTN after chemotherapy.Summary the Basic clinical data,treatment and fertility outcome with clinical follow-up.Results1.Clinical characteristics:The age of 11 patients was from 24 to 50 years old with the average age of 37.2 years old.6 of them have reproductive requirement.Five patients'(45%)clinical features are sudden vaginal bleeding with no obvious symptoms like floodgate,and accompanied by dizziness,fatigue,anemia symptoms such as syncope;4 cases(36%)have no obvious clinical symptoms;In 2 cases(19%)for persistent vaginal bleeding.The period time range from undergoing chemotherapy to the diagnosis of uterine AVM in 11 patients is larger(2 days-13 years),but there are 8 cases(73%)diagnosed with uterine AVM in the first course of chemotherapy.High range of blood hCG value in 11 patients Diagnosed with AVM is 9.2.Imaging characteristics:6 cases of 11 patients with color doppler ultrasound show the heterogeneity echo in uterine wall,with circuitous tubular dark space,CDFI:blood flow signal is rich and colorful,with arteriovenous fistula spectrum;In 1 case,the heterogeneity echo in uterine wall with abundant blood flow signals is a kind of high velocity and low resistance type;3 cases show irregular dark space in uterine cavity and the muscle layer,with rich blood flow signal.The MRI of 2 cases show a empty vessels flow void with diffuse,circuitous and expansive in strips around the uterine wall,and bulky vessels.3.Treatment outcome:4 patients chose embolization of uterine artery cause sudden vaginal bleeding,and had effective control of vaginal bleeding after treatment,and no long-term bleeding?6 cases required hysterectomy because of no desired pregnancy,1 of them could not control the vaginal bleeding after twice embolizations then doing emergency hysterectomy?1 case had not special treatment due to pregnancy.4.Birth outcomes:1 of the 4 patients with successful arterial embolization gave birth to a child in more than 2 years later;2 cases had not pregnancy again;the chemotherapy of 1 case is still in progress.6 cases required hysterectomy had effective control of vaginal bleeding after treatment,and no long-term bleeding.1 case had not special treatment due to pregnancy successfully delivered.Conclusion1.GTN after chemotherapy can occur uterine arteriovenous fistula,clinicians should raise awareness of the disease.In patients with acute hemorrhage should do emergency uterine artery angiography,as well as diagnosis,and treatment to control bleeding.2.The preferred treatment for AVF is uterine artery embolization,not only can remian the patients' reproductive function,but also do well for the next step of chemotherapy;If there is uncontrollable pelvic hemorrhage after embolization,we should do emergency hysterectomy,and save the patient's life.3.Uterine arteriovenous fistula of GTN after chemotherapy have some high risk factor,including hCG-0,previous pregnancy and position of lesions.