Purpose: To investigate efficacy, safety and fertility outcomes of bilateral Uterine Artery Embolization (UAE) in the treatment of acquired uterine arteriovenous malformations (AVMs).
Material and Methods: We evaluated all the patients diagnosed with acquired uterine AVM (clinically and through imaging studies) treated with bilateral Uterine Artery Embolization (UAE) in our radiology department between January 2016 and January 2020. Demographic data, clinical presentation, technical success rate of embolization, procedure-related complications, related surgical and medical treatments and clinical follow-up data were assessed.
Results: 32 patients with ultrasound features consistent with uterine AVM were treated with bilateral UAE. Average age was 32 years (19-41). 28/32 (87%) of the patients presented with bleeding (two of them with heavy bleeding), while 4/32 (13%) were asymptomatic. MAV was related to spontaneous abortion in 13/32 patients (40%), to surgical abortion in 6/32 patients (19%), to medical abortion in 6/32 patients (19%), to spontaneous or cesarean delivery in 6/32 patients (19%), to surgery (myomectomy) in 1/32 patients (3%). Half (16/32) of the patients had a history of past uterine surgery (including curettage). Microspheres ranging from 500 to 1100 μm (800 +/- 75 μm in 30/32 patients) were used in all the patients and microcoils in one patient. No further treatments were required in 20/32 patients. Two patients had to repeat UAE for persistent bleeding; in one of these cases endometrial trophoblastic disease was subsequently diagnosed. 10/32 (31%) procedures were completed by surgical interventions (mostly curettage) but only in one patient due to persisting AVM at the first ultrasound control; in this case AVM was associated with a complete hydatidiform mole and the patient underwent laparoscopic ligation of the uterine arteries and hysteroscopy with removal of ovular material. No procedure-related complication was observed. Several months after embolization six patients completed a pregnancy and one patient got pregnant but miscarried in the 9th week.
Conclusions: Uterine arteriovenous malformations (AVMs) are a rare but potentially life-threatening cause of abnormal uterine bleeding, usually diagnosed in young women that wish to carry future pregnancies. Uterine Artery Embolization (UAE) is a safe and effective treatment of uterine AVM that does not affect fertility.