J Korean Soc Radiol.  2017 Feb;76(2):104-110. 10.3348/jksr.2017.76.2.104.

Acquired Uterine Vascular Malformation: Clinical Outcome of Transarterial Embolization

• Kang CH
• Yang SB
• Goo DE
• Kim YJ
• Lee JM
• Lee WH

• KMID: 2367857
• DOI: http://doi.org/10.3348/jksr.2017.76.2.104

Abstract

PURPOSE
To evaluate clinical outcomes of transarterial embolization of bilateral uterine arteries (UAE) in patients with acquired uterine vascular malformation (UVM).
MATERIALS AND METHODS
This retrospective study was performed on the medical records of all 19 patients who underwent transarterial embolization of bilateral UAE for the treatment of symptomatic UVMs from January 2003 to June 2011. Embolization was performed via the unilateral femoral artery approach with a catheter and angiographic techniques. Clinical success was defined as definitive resolution of abnormal vaginal bleeding. Post-procedural complications included all adverse events related to the embolization procedure.
RESULTS
A total of 20 procedures were performed in 19 patients. One patient required repeat embolization because of incomplete embolization related to prominent high flow malformation. Clinically, in all patients, bleeding was controlled immediately after embolization. No complications occurred in all patients during the follow up period. In all patients who underwent successful UAE, menstrual cycles were normally restored within 1-2 months. Normal pregnancy with term delivery was observed in two of the 19 cases.
CONCLUSION
Transarterial bilateral UAE is a safe and effective treatment in patients with vaginal bleeding caused by acquired UVM, and it allows the possibility of future pregnancy.

MeSH Terms

Angiography
Arteriovenous Malformations
Catheters
Female
Femoral Artery
Follow-Up Studies
Hemorrhage
Humans
Medical Records
Menstrual Cycle
Pregnancy
Retrospective Studies
Uterine Artery
Uterine Hemorrhage
Uterus
Vascular Malformations*

Figure

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  Fig. 1 A 27-year-old woman presented with vaginal bleeding for 2 months after D & E. Gray-Scale ultrasonogram (A) shows a cystic mass in the uterus. Color Doppler ultrasonogram (B) reveals a pseudoaneurysm. Selective left uterine angiogram (C) shows a pseudoaneurysm in the uterus. Completion uterine angiogram (D) after uterine artery embolization with gelatin sponge particles reveals the disappearance of pseudoaneurysm with occlusion of the uterine artery. Color Doppler ultrasonogram (E) obtained two days after embolization reveals complete thrombosis of the pseudoaneurysm.

• 

  Fig. 2 A 30-year-old woman presented with intermittent vaginal bleeding for 1 month after missed abortion. Transvaginal Gray-Scale (A) and color Doppler (B) ultrasonograms show a tangle of tortuous vessels with increased vascularity in the uterine fundus. Selective left uterine angiogram (C, D) demonstrates an hypertrophied uterine artery and a vascular mass lesion with early venous drainage during the arterial phase. Post-embolization pelvic angiogram (E) shows eradication of the vascular mass and complete occlusion of the uterine artery.

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