Uterine Arteriovenous Malformations: Primary Treatment with Therapeutic Embolization

Uterine arteriovenous malformations are rare lesions that can cause massive vaginal bleeding and spontaneous abortions. The majority are either congenital or related to gestational trophoblastic disease. Hysterectomy has been the treatment of choice. The authors successfully treated four patients with symptomatic uterine arteriovenous malformations by means of transcatheter embolization; three of the lesions were related to gestational trophoblastic disease and one was congenital. All were supplied by the uterine arteries that were subselectively embolized with particulate material. This resulted in prompt cessation of uterine hemorrhage. There were no complications, and one pregnancy was achieved. The three other women have normal menstruation and no recurrence of bleeding at follow-up 10–48 months after treatment. On the basis of this experience and that of others, embolotherapy should be the treatment of first choice in these lesions, as it appears safe and effective. Additionally, uterine function is preserved in patients who are usually reproductively active.