International Journal of Current Medical And Applied Sciences .vol.1.

Issue: 2, 2013, PP 01-03

Arteriovenous Malformation: A rare cause of

Menorrhagia, treated successfully by Uterine Artery
Embolization.
Shubhangi Mande*, Sangeeta Chippa**, Dipti vaidya** Swati Shiradkar***
*Associate Professor , **Assistant Professor , ***HOD & Professor.
Department of Obstetrics and Gynaecology, Mahatma Gandhi Missions Medical College and
Hospital, Aurangabad, Maharashtra, INDIA.
Corresponding Email Address: pramod.bhale@gmail.com, c_sangeeta12@rediffmail.com,

Case Study
Subject: Obstetrics and Gynaecology
Abstract:
Arteriovenous malformation is a rare
cause of menorrhagia but it can cause major
bleeding. It is diagnosed by MRI and
angiography. Previously surgery was the only
option for its treatment. But uterine artery
embolization provides a good, fertility saving
alternative for the treatment of chronic genital
bleeding. Here we are presenting a case of
menorrhagia with severe anaemia with
congestive cardiac failure. She was
investigated for the same and found to be
having arteriovenous malformation which was
treated successfully with uterine artery
embolization.

Uterine Arteriovenous Malformation

is a rare cause of menorrhagia which should be
ruled out in refractory cases not responding to
conventional measures. Bleeding is a major
presenting symptom in uterine Arteriovenous
Malformation and it can cause life threatening
massive genital bleeding in young women.
Acquired uterine arteriovenous malformations
are associated with obstetric conditions like
multiple pregnancy, spontaneous abortions and
with procedures like Dilatation & curettage
and caesarean section [2]. They can also be
associated with normal vaginal birth or
malignancy [3].

Key words:

Uterine arteriovenous malformations

can be diagnosed with grey scale and colour
Doppler
ultrasound,
MRI
and
CT
Angiography. In MRI, findings like tortuous
and coiled vessels within a thickened
myometrium are a hallmark of uterine
Arteriovenous malformations. Angiography
remains the gold standard imaging technique
in diagnosis [4].

Arteriovenous malformation,
Uterine Artery Embolization etc.

Introduction:
In arteriovenous malformations,
arteries and veins are connected directly rather
than through capillaries. This direct connection
produces enlarged, tangled masses of blood
vessels that are prone to rupture and bleeding.
Arteriovenous malformations of uterus are
abnormal connection between uterine arteries
and uterine veins [1]. They are extremely rare
and can occur either in congenital or acquired /
traumatic form.

In the past it was mainly treated by

hysterectomy. But recently uterine artery
embolization has evolved as a effective
modality of treatment for patients with
arteriovenous malformation who present with

Copyright @ 2013 Logic Publications, IJCMAAS,E-ISSN:2321-9335,ISSN:2321-9327(Print) page I 01

Shubhangi Mande, Sangeeta Chippa, Dipti vaidya & Swati Shiradkar

chronic genital bleeding as a fertility saving
conservative line of management 5 uterine
artery is embolized with micro particles, coils
or glue. Collateral vascular supply maintains
the uterine perfusion thus, preserving fertility
[6,7].

As patient was young and willing

for conservative management for preservation
of her fertility case was discussed with
interventional radiologist. And the decision of
uterine artery embolization was taken after
discussion with relatives about the prognosis.

Here we are presenting a case of

menorrhagia with severe anaemia in a young
lady with arteriovenous malformation which
was successfully treated by uterine artery
embolization.

Uterine artery embolization was done

and postoperatively patient was started on oral
contraceptive pills. On follow up, patient was
relieved of her complaint of menorrhagia.

Discussion:
Case report:
24 years, P1L1, delivered vaginally
4 months back, presented to us as a case of
menorrhagia since 5yrs with severe anaemia
with congestive cardiac failure. History
revealed that, patient was a case of infertility
for which she underwent dilatation and
curettage 5 years back and since then she
developed menorrhagia for last 5 years.
On admission, she was in cardiac
failure due to severe anaemia with
haemoglobin of 2.6gm%, hematocrit 9%, RBC
1.5million, with normal platelet count. Her
uterine height on admission was 14weeks. So,
our first differential diagnosis was placental
site polyp and the second differential diagnosis
was choriocarcinoma which were ruled out by
normal 1 beta-hCG and Ultrasound report of
bulky uterus with thick and heterogenous
endometrium. Initial management of cardiac
failure and anaemia correction was done to
stabilize patient medically. In total she was
given five units of packed cell volume.
We further investigated her to
determine the cause of her menorrhagia.
Thyroid function test were normal, sickling
test was negative and her MRI was suggestive
of
arteriovenous
malformation
with
adenomyosis. Diagnosis of arteriovenous
malformation was further confirmed by
angiography.

Uterine
arteriovenous
malformation results from formation of
multiple
arteriovenous
fistulous
communications within the uterus without an
intervening capillary network. Acquired
traumatic uterine arteriovenous malformation
consists of multiple small arteriovenous
fistulas between intramural arterial branches
and myometrial venous plexus [8].
In our case uterine arteriovenous
malformation was acquired in nature as
patients symptoms started after dilatation and
curettage for infertility investigation. It was
diagnosed by MRI and angiography.
In past hysterectomy was the only
treatment
for
uterine
arteriovenous
malformation. But, recent reports have
mentioned
successful
conservative
management such as surgical removal of
arteriovenous malformation, uterine artery
embolization and laparoscopic bipolar
coagulation of uterine artery and long term
medical therapy.
Transcatheter arterial embolization
is a highly effective percutaneous technique
for treatment of uterine Arteriovenous
Malformation and also for controlling chronic
genital bleeding [9]. It has several advantages
over surgery, which includes higher success
rate, less morbidity, avoidance of anaesthetic

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Sciences Page | 2

International Journal of Current Medical And Applied Sciences .vol.1. Issue: 2, 2013.
complications and preservation of fertility
[10]. Reported success rate of Uterine Artery
Embolization in obstetric haemorrhage is 90%
[11,12].
In our case, considering the age and
parity of the patient decision of uterine artery
embolization was taken as, she was not
responding to medical treatment which she
received in the past. Postoperatively she was
started on oral contraceptive pills. In
subsequent menstrual cycle, she had less
amount of bleeding.
Conclusion:
In this case report, patient was
suffered from menorrhagia with severe
anaemia with congestive cardiac failure. She
was investigated for the same and found to be
having arteriovenous malformation which was
treated successfully with uterine artery
embolization.

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Copyright @ 2013 Logic Publications, IJCMAAS,E-ISSN:2321-9335,ISSN:2321-9327(Print)