Clinical experience with postpartum treatment of a patient with arteriovenous malformation of uterine vessels

Abstract

Uterine arteriovenous malformation is a rare vascular dysplasia where the uterine veins communicate with the branches of arteries of varying calibers. Patient K., a 37-years-old patient, presented with genital tract bleeding. Her medical history included operative labor at 37 weeks with dichorionic diamniotic twins, with the placental site on the posterior uterine wall exhibited firm attachment. The uterine cavity walls were scraped, and the bleeding vessel in the placental site was sutured. The blood loss amounted to 750 mL, and reinfusion was conducted. Fourteen days after giving birth, a heavy bloody discharge with blood clots from the genital tract occurred. The blood tests revealed no abnormalities. Echography detected multiple tubular structures that were anechoic on the posterior wall of the uterus, from the endometrium to the serosa, with the CDC mode blood flow. Magnetic resonance angiography revealed hypervascularization with premature arteriovenous discharge. Superselective embolization was performed on uterine artery afferents, and complete blood flow reduction was achieved, leading to the cessation of bleeding. On postoperative day 17, the patient experienced considerable bloody discharge from the genital tract, causing the hemoglobin level to decrease to 88 g/L. The presence of an arteriovenous malformation in the uterine vessels accompanied by ineffective embolization necessitated uterine extirpation. The postoperative phase was uneventful, and the patient was discharged from the hospital in satisfactory condition, with no evidence of anemia (hemoglobin, 115 g/L).

Keywords

blood flow reduction / hypervascularization / magnetic resonance angiography / uterine arteriovenous malformation / uterine artery embolization

References

[1] Acien P, Acien MH, Sánchez-Ferrer M. Complex malformations of the female genital tract. New types and revision of classification. Hum Reprod. 2004;19(10):2377–2384. doi: 10.1093/humrep/deh423

[2] Acien P., Acien M.H., Sánchez-Ferrer M. Complex malformations of the female genital tract. New types and revision of classification // Hum Reprod. 2004. Vol. 19, N. 10. P. 2377–2384. doi: 10.1093/humrep/deh423

[3] Beller U, Rosen RJ, Beckman EM, Markoff G, Berenstein A. Congenital arteriovenous malformation of the female pelvis: a gynecological perspective. Am J Obstet Gynecol. 1988;159(5):1153–1160. doi: 10.1016/0002

[4] Beller U., Rosen R.J., Beckman E.M., Markoff G., Berenstein A. Congenital arteriovenous malformation of the female pelvis: a gynecological perspective // Am J Obstet Gynecol. 1988. Vol. 159, N. 5. P. 1153–1160. doi: 10.1016/0002

[5] Kasznica J, Nissar N. Congenital vascular malformation of the uterus in stillborn: a case report. Hum Pathol. 1995;26(2):240–241. doi: 10.1016/0046

[6] Kasznica J., Nissar N. Congenital vascular malformation of the uterus in stillborn: a case report // Hum Pathol. 1995. Vol. 26, N. 2. P. 240–241. doi: 10.1016/0046

[7] Aiyappan SK, Ranga U, Veeraiyan S. Doppler sonography and 3D CT angiography of acquired uterine arteriovenous malformations (AVMs): report of two cases. J Clin Diagn Res. 2014;8(2):187–189. doi: 10.7860/JCDR/2014/6499.4056

[8] Aiyappan S.K., Ranga U., Veeraiyan S. Doppler sonography and 3D CT angiography of acquired uterine arteriovenous malformations (AVMs): report of two cases // J Clin Diagn Res. 2014. Vol. 8, N. 2. P. 187–189. doi: 10.7860/JCDR/2014/6499.4056

[9] Lin AC, Hung YC, Huang LC, Chiu TH, Ho M. Successful treatment of uterine arteriovenous malformation with percutaneous embolization. Taiwan J Obstet. Gynecol. 2007;46(1):60–63. doi: 10.1016/S1028

[10] Lin A.C., Hung Y.C., Huang L.C., Chiu T.H., Ho M. Successful treatment of uterine arteriovenous malformation with percutaneous embolization // Taiwan J Obstet Gynecol. 2007. Vol. 46, N. 1. P. 60–63. doi: 10.1016/S1028

[11] Valenzano M, Foglia G, Tedeschi C, Paoletti R, Fulcheri E. Color Doppler sonography of uterine arteriovenous malformation. J Clin Ultrasound. 2000;28(3):146–149. doi: 10.1002/(sici)1097

[12] Valenzano M., Foglia G., Tedeschi C., Paoletti R., Fulcheri E. Color Doppler sonography of uterine arteriovenous malformation // J Clin Ultrasound. 2000. Vol. 28, N. 3. P. 146–149. doi: 10.1002/(sici)1097

RIGHTS & PERMISSIONS

Eco-Vector