Trans-arterial embolization of acquired uterine arteriovenous malformation after Cesarean section: A case series

Abstract

Background: Acquired uterine arteriovenous malformation (AVM) is a rare condition

due to traumatic episodes in cesarean section. The patient can suffer from lifethreatening

hemorrhage or recurrent vaginal bleeding. Establishing this diagnosis is

difficult, often misdiagnosed due to lack of information and number of cases. Trans-

Arterial Embolization (TAE) procedure is rarely performed in our center. All of the

cases were found with history of massive bleeding and diagnosed lately after recurrent

bleeding history. Even though promising, one of our cases failed to be managed with

TAE. It is important to diagnose early symptoms of AVM in order to prevent the life

threatening event.

Case presentation: In these case series, four cases of AVMs after cesarean procedures

will be reviewed. One could be diagnosed in less than a month but the other three took

several months. The symptom of vaginal bleeding might occur a few weeks after the

procedure is done, and most patients need transfusion and hospitalization. Three out of

four patients were initially sent to the hospital in order to recover from shock condition,

and one patient was sent for a diagnostic procedure. AVMs diagnostic was established

with ultrasound with or without angiography. Three of our cases were succeeded by

performing TAE procedure without further severe vaginal bleeding. One case failed to

be treated with embolization and had to proceed with hysterectomy.

Conclusion: AVM should be considered early-on in patient with abnormal uterine

bleeding and history of cesarean section. Embolization is still the first-choice treatment

of AVMs, otherwise definitive treatment is hysterectomy in a patient without fertility

need, or impossible to perform TAE.