Case Report
Ravi Srinivasa, Patricia Bu
Abstract
Purpose: Uterine AVMs are difficult to treat using conventional surgical techniques due to the high patient morbidity secondary to complex vascularity. Transcatheter embolotherapy has become a suitable option in the setting of large pelvic arteriovenous malformations as a significantly safer alternative to surgery offering great patient outcomes and shorter recovery times. We report two cases of large uterine arteriovenous malformations successfully embolized with N-butyl cyanoacrylate with near complete remission of patient symptoms. Case Reports: Two patients are presented one premenopausal and one postmenopausal both of whom had large uterine arteriovenous malformations which were resulting in significant bleeding. Results: The first patient had a large AVM which was treated solely through transcatheter methods with N-butyl cyanoacrylate (n-BCA) glue embolotherapy of the right ovarian artery and bilateral uterine arteries. The second patient had a markedly complex AVM draining into a hypertrophied left gonadal vein which was treated with a combination of transarterial and transvenous catheter embolotherapy with coils and n-BCA as well as direct percutaneous puncture with STS foam sclerotherapy of a dominant nidus. Both had good outcomes with the second patient having a 4 year follow-up arteriogram revealing no further filling of the AVM. Conclusion: A combination transcatheter and percutaneous sclerotherapy approach with embolization of the nidus, outflow vein and arterial inflow can eradicate uterine AVMs and dramatically improve patient outcomes, preserving patient fertility with limited morbidity and high success rates. In general, particulate embolization should be avoided in large AVMs due to the high risk for AV-shunting.