Transcatheter Percutaneous Embolotherapy of Uterine Arteriovenous Malformations: A Report of 2 CasesRavi Srinivasa*, Patricia Burrows, Arun Reghunathan and Alan Cohen
Interventional Radiology, The University of Texas Medical School at Houston, Houston, Texas, USA
- *Corresponding Author:
- Ravi Srinivasa
Assistant Professor, Interventional Radiology
The University of Texas Medical School at Houston
Houston, Texas, USA
Tel: 713 704 4972
E-mail: [email protected]
Received date July 22, 2015; Accepted date July 22, 2015; Published date July 28, 2015
Citation: Srinivasa R, Burrows P, Reghunathan A, Cohen A (2015) Transcatheter Percutaneous Embolotherapy of Uterine Arteriovenous Malformations: A Report of 2 Cases. J Women’s Health Care 4:247. doi:10.4172/2167-0420.1000247
Copyright: © 2015 Srinivasa R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Purpose: Uterine AVMs are difficult to treat using conventional surgical techniques due to the high patient morbidity secondary to complex vascularity. Transcatheter embolotherapy has become a suitable option in the setting of large pelvic arteriovenous malformations as a significantly safer alternative to surgery offering great patient outcomes and shorter recovery times. We report two cases of large uterine arteriovenous malformations successfully embolized with N-butyl cyanoacrylate with near complete remission of patient symptoms. Case Reports: Two patients are presented one premenopausal and one postmenopausal both of whom had large uterine arteriovenous malformations which were resulting in significant bleeding. Results: The first patient had a large AVM which was treated solely through transcatheter methods with N-butyl cyanoacrylate (n-BCA) glue embolotherapy of the right ovarian artery and bilateral uterine arteries. The second patient had a markedly complex AVM draining into a hypertrophied left gonadal vein which was treated with a combination of transarterial and transvenous catheter embolotherapy with coils and n-BCA as well as direct percutaneous puncture with STS foam sclerotherapy of a dominant nidus. Both had good outcomes with the second patient having a 4 year follow-up arteriogram revealing no further filling of the AVM. Conclusion: A combination transcatheter and percutaneous sclerotherapy approach with embolization of the nidus, outflow vein and arterial inflow can eradicate uterine AVMs and dramatically improve patient outcomes, preserving patient fertility with limited morbidity and high success rates. In general, particulate embolization should be avoided in large AVMs due to the high risk for AV-shunting.