Published: 2021-06-28

Uterine artery embolization for uterine arterio-venous malformation

Haritha Sagili, Nagarajan Krishnan, Anish Keepanasseril, Sathiya Priya, Sunilkumar Devaraj


Uterine arteriovenous malformations (AVM) as a cause of abnormal uterine bleeding are listed under “not otherwise classified” in Palm-Coein classification, is an abnormal communication between an artery and vein without an intervening capillary bed resulting in increased pressure and high velocity in the venous system. We report the case of heavy menstrual bleeding in a thirty-five-year-old primiparous lady for five years with fourteen weeks sized uterus and six gm hemoglobin. Ultrasound revealed an enlarged uterus with tubular spaces and color doppler showed tubular anechoic structures, both within the myometrium, with low resistance and high-velocity pattern suggestive of uterine arteriovenous malformations. Because of nonresponse to medical management, uterine artery embolization was carried out following which she had significant reduction in menstrual bleeding emphasizing it as a differential diagnosis in all cases presenting with heavy menses. Uterine artery embolization appears to be an effective modality of treatment especially in women whose wish to preserve fertility.


Uterine artery embolization, Heavy menstrual bleeding, Uterine arterio-venous malformation

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Munro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynecol Obstetr. 2018;143(3):393-408.

O’Brien P, Neyastani A, Buckley AR, Chang SD, Legiehn GM. Uterine arteriovenous malformations: from diagnosis to treatment. J Ultrasound Med. 2006;25(11):1387-92.

Grivell RM, Reid KM, Mellor A. Uterine arteriovenous malformations: a review of the current literature. Obstet Gynecol Surv. 2005;60(11):761-7.

Polat P, Suma S, Kantarcý M, Alper F, Levent A. Color Doppler US in the evaluation of uterine vascular abnormalities. Radiographics. 2002;22(1):47-53.

Fleming H, Ostör AG, Pickel H, Fortune DW. Arteriovenous malformations of the uterus. Obstet Gynecol. 1989;73(2):209-14.

Hickey M, Fraser IS. Clinical implications of disturbances of uterine vascular morphology and function. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14(6):937-51.

Chen L-K, Yang B-L, Chen K-C, Tsai Y-L. Successful Transarterial Embolization of Uterine Arteriovenous Malformation: Report of Three Cases. Iran J Radiol. 2016;13(1):e15358.

Kwon JH, Kim GS. Obstetric iatrogenic arterial injuries of the uterus: diagnosis with US and treatment with transcatheter arterial embolization. Radiographics. 2002;22(1):35-46.

Yang JJ, Xiang Y, Wan XR, Yang XY. Diagnosis and management of uterine arteriovenous fistulas with massive vaginal bleeding. Int J Gynaecol Obstet. 2005;89(2):114-9.

Eling R, Kent A, Robertson M. Pregnancy after uterine arteriovenous malformation-case series and literature review. Australas J Ultrasound Med. 2012;15(3):87-96.

Peitsidis P, Manolakos E, Tsekoura V, Kreienberg R, Schwentner L. Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review. Arch Gynecol Obstet. 2011;284(5):1137-51.