ACQUIRED UTERINE ARTERIOVENOUS MALFORMATION: CASE REPORT AND UPDATE ON MEDICAL AND ENDOSCOPIC TREATMENT

Chimi Hanae*, Khaoula Laboub, Maakoul Rachid, Lakouit Rababe and Bargach Samir

ABSTRACT

Introduction: Uterine arteriovenous malformations (AVM) are extremely rare, is characterized by an abnormal
direct connection between an arterial network and a venous network, without the involvement of capillaries .
Acquired uterine arteriovenous malformations (UAVMs) are rarely discussed in the context of persistent
metrorrhagia following a complicated pregnancy. It is crucial to consider them to avoid potentially dangerous and
unnecessary hemostatic curettage for the patient. Here, we describe a case of acquired intrauterine arteriovenous
malformations occurring after abortion. Case presentation: A 29-year-old woman with no significant medical
history experienced severe postpartum metrorrhagia following a recent spontaneous abortion. She required
hospitalization and two blood transfusions. Diagnostic imaging (Doppler ultrasound, CT angiography, and
arteriography) revealed a fundal arteriovenous malformation, primarily supplied by the left uterine artery. Selective
embolization with non-resorbable particles and coils was performed. Postoperative imaging showed significant
devascularization of the AVM, and follow-up indicated resolution of metrorrhagia, irregular but normal menstrual
cycles, and complete disappearance of the malformation within one month. Discussion: Uterine arteriovenous
malformations can be congenital or acquired, presenting with symptoms such as bleeding, pain, and fertility issues.
Congenital AVMs are associated with genetic syndromes, while acquired AVMs often result from trauma or
medical procedures. Diagnostic tools, including ultrasound and Doppler, provide detailed views of these vascular
anomalies, aiding in accurate diagnosis and management. MRI and angiography further assist in evaluating the
lesions. Treatment varies based on lesion characteristics, with hysterectomy considered a last resort. Minimally
invasive methods, such as embolization, are preferred due to their high success rates and ability to preserve
fertility. Medical management of symptomatic uterine AVM is a reasonable approach in a well selected patient
who is hemodynamically stable and has reliable follow-up. Conclusion: AVMs are a rare but potentially serious
cause of life threatening vaginal bleeding. A high index of suspicion is needed so that a prompt diagnosis can be
made. Acquired AVMs should be considered when metrorrhagia persists in the postpartum period. Early diagnosis
through pelvic ultrasound combined with Doppler allowed for conservative treatment by embolization in our
patient.

Keywords: Uterine arteriovenous malformations, ultrasound with color Doppler, arterial embolization, medical treatment, fertility.