Arteriovenous Malformations of the Uterus

TLDR

Arteriovenous malformations of the uterus are rare gynecologic lesions, with only 73 reported cases, typically presenting with vaginal hemorrhage but also with congestive heart failure, postmenopausal bleeding, or as an asymptomatic mass, and they may be congenital or acquired following trauma or gynecologic malignancies such as choriocarcinoma. Diagnosis is rapidly achieved with color‑flow Doppler ultrasound or angiography, and can also be detected by hysteroscopy, hysterosalpingography, or CT; acute management involves hemodynamic stabilization and possible Foley bulb placement or methylergonovine injection, while definitive treatment—embolization or hysterectomy—depends on fertility desires and embolization success. Embolization therapy is variably successful and can preserve reproductive capacity, with five pregnancies reported after embolization, though outcomes vary.

Abstract

Arteriovenous malformations (AVM) are rare entities in gynecology, with only 73 cases reported in the literature.Most commonly they present with vaginal hemorrhage, but other presentations such as congestive heart failure, postmenopausal bleeding, and an asymptomatic mass have been described. These lesions may be congenital or acquired. Acquired lesions are believed to follow trauma or may arise after choriocarcinoma or other gynecologic malignancies. Diagnosis can rapidly be made with color flow Doppler ultrasound or angiography. Additionally, they have been detected using hysteroscopy, hysterosalpingogram, and computerized tomography. Acute management consists of hemodynamic stabilization and possibly placement of a Foley bulb in the uterus or methylergonovine injection. Ultimate treatment depends on the patients desire for fertility. Embolization therapy is variably successful and may allow the preservation of reproductive capacity. To date, five pregnancies after embolization have been reported with varying outcomes. If pregnancy is not desired or embolization fails, hysterectomy remains the treatment of choice.