Embolization of Uterine Arteriovenous Malformations

Uterine arteriovenous malformations are a rare cause of vaginal bleeding in women of childbearing age and can represent a life-threatening condition. There are two forms of uterine arteriovenous malformation: congenital and acquired. The former has a complex structure, possible extra-pelvic extension, and a higher rate of retreatment, while the latter is often secondary to uterine trauma (such as cesarean section, dilatation and curettage, gynecological tumors), is limited to the myometrium, and usually resolves with a single treatment. Diagnostic suspicion is raised by transvaginal ultrasound with power doppler, and the main findings are hypoechogenic tubular structures within the myometrium, characterized by pronounced vascularization and turbulence. The diagnosis is confirmed by contrast-enhanced magnetic resonance or computed tomography. The treatment of choice is endovascular with uterine artery embolization, with a high success rate, up to 90%. There is no equivocal consensus in either the choice of technique or embolizing agent so the choice is usually based on the preference of the interventional radiologist. In case this treatment fails, surgery with hysterectomy is recommended.