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

Abstract

Background: Acquired uterine arteriovenous malformation (AVM) is a rare conditiondue to traumatic episodes in cesarean section. The patient can suffer from lifethreateninghemorrhage or recurrent vaginal bleeding. Establishing this diagnosis isdifficult, often misdiagnosed due to lack of information and number of cases. Trans-Arterial Embolization (TAE) procedure is rarely performed in our center. All of thecases were found with history of massive bleeding and diagnosed lately after recurrentbleeding history. Even though promising, one of our cases failed to be managed withTAE. It is important to diagnose early symptoms of AVM in order to prevent the lifethreatening event.Case presentation: In these case series, four cases of AVMs after cesarean procedureswill be reviewed. One could be diagnosed in less than a month but the other three tookseveral months. The symptom of vaginal bleeding might occur a few weeks after theprocedure is done, and most patients need transfusion and hospitalization. Three out offour 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 establishedwith ultrasound with or without angiography. Three of our cases were succeeded byperforming TAE procedure without further severe vaginal bleeding. One case failed tobe treated with embolization and had to proceed with hysterectomy.Conclusion: AVM should be considered early-on in patient with abnormal uterinebleeding and history of cesarean section. Embolization is still the first-choice treatmentof AVMs, otherwise definitive treatment is hysterectomy in a patient without fertilityneed, or impossible to perform TAE.