A rare case of disseminated uterine arteriovenous malformation

Background: Uterine arteriovenous malformation (AVM) is a fairly rare disease that occurs mainly among reproductive-aged women. The clinical symptoms of uterine AVM are variable: from incidental ultrasound findings to profuse uterine bleeding as a result of spontaneous rupture of altered vessels. The feature of this bleeding is the lack of effect of medical treatments. Case report: Female patient S., born in 1971, was admitted to the V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology to receive organ-sparing treatment for AVMs in the uterus and right iliac region. It follows from her medical records that the patient was diagnosed to have an elevated human chorionic gonadotropin level after a right-sided tubal pregnancy in 2006. She was also diagnosed with trophoblastic disease. At further gynecological follow-up, the patient had dilated uterine and pelvic vessels, as evidenced by echo color Doppler sonography. In 2013, there was an episode of massive menometrorrhagia. Control ultrasound suspected uterine vascular malformation. The diagnosis was verified by CTangiography. Based on the examination results, an angiosurgeon carried out a consultation; a technically successful bilateral embolization of the uterine arteries (UAE) and branches of the internal iliac arteries was performed. Control angiograms indicated a sharply reduced blood supply to the pathological vascular plexus. Conclusion: UAE is presently a priority treatment for uterine AVM, which allows hysterectomy to be avoided in reproductive-aged women.

uterine arteriovenous malformation, AVM, vascular anomaly, computed tomography, MSCT, angiography, uterine artery embolization, UAE