Women's & Men's Health

Session: Educational Exhibit Presentations - Station 12: Women's & Men's Health

Treatment of Uterine Arteriovenous Malformations: A Primer

Monday, March 6, 2023

5:05 PM – 5:10 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Dhiraj Sikaria, MD

Resident
Beth Israel Deaconess Medical Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

SS

Sarah Schroeppel DeBacker, MD

Interventional Radiologist
Beth Israel Deaconess Medical Center
OB

Olga Brook, MD, MBA, FSIR, FSAR

Section Chief of Abdominal Imaging and Interventions
Beth Israel Deaconess Medical Center
Julie C. Bulman, MD

Interventional Radiologist
Beth Israel Deaconess Medical Center, Harvard Medical School

Disclosure(s):

Dhiraj Sikaria, MD: No financial relationships to disclose

Olga Brook, MD, MBA, FSIR, FSAR: No financial relationships to disclose

Julie C. Bulman, MD: Argon Medical Devices: Consultant (Ongoing)

Learning Objectives:

Discuss the etiology, diagnosis, and management of uterine arteriovenous malformations (UAVMs).

Technical review describing commonly used devices, approaches, and post-procedural management.

Provide an overview of outcome data regarding embolization of UAVMs.

Background:

UAVM is a potentially life-threatening condition which can cause menorrhagia requiring transfusion. UAVMs can be congenital or more often acquired in the setting of gynecologic procedures, specifically dilation and curettage (D&C). The reported incidence of UAVM is variable and may represent as little as 2% of pelvic hemorrhages. Other presenting symptoms can include pain or recurrent miscarriage. Beta-HCG is recommended in the setting of prior pregnancy to rule out retained products of conception or gestational trophoblastic disease. High clinical suspicion or screening pelvic Doppler sonography showing evidence of UAVM including echogenic tissue or vascular tortuosity with elevated peak systolic velocities can prompt further imaging in conjunction with Interventional Radiology consultation.

Clinical Findings/Procedure Details:

Treatment depends on multiple patient characteristics including desired fertility and includes expectant management (EM), uterine artery embolization (UAE), and surgery. Clinical IR evaluation is necessary in determining which patients can undergo EM and who requires procedural intervention. UAE has high clinical success, and gelfoam embolic has lower infertility risk due to its temporary nature. Counseling is an important component of comprehensive patient care in deciding on treatment algorithm and close follow-up is needed in this patient population to ensure UAVM resolution. We describe the clinical management of UAVM and present 2 cases of expectant management and 4 cases of gelfoam embolization for the treatment of UAVM. Pre-procedure evaluation with diagnostic ultrasound and MRI evaluation, diagnostic arteriography and outcomes data will also be discussed.

Conclusion and/or Teaching Points:

The treatment of uterine arteriovenous malformations ranges from expectant management to embolization to hysterectomy, with clinical indications for each option. UAE is a successful and safe treatment option for UAVMs that fail expectant management and can help prevent life-threatening hemorrhage while preserving future fertility. The viewer will gain a better understanding of the endovascular techniques and peri-procedural management required for appropriate care.