The Role of Embolization in Acquired Uterine Vascular Malformations: A Single-Center Study in India

Purpose: To determine the efficacy of uterine artery embolization (UAE) in patients with bleeding acquired uterine arteriovenous malformations (AVMs).

Materials and Methods: A prospective review of all patients who underwent UAE at our institution between July 2012 and December 2020 was performed. A total of 225 patients were diagnosed with a uterine vascular malformation on Doppler and corresponding magnetic resonance imaging. Serial β-human chorionic gonadotropin levels were measured to exclude gestational trophoblastic neoplasia. All patients underwent transcatheter embolization of the uterine arteries. Embolizations were performed with use of standard 5-Fr Robert’s Uterine catheter and 2.7-Fr Progreat microcatheter when necessary. Embolic agents in the 375 procedures included glue only (n = 326), polyvinyl alcohol (PVA) particles and glue (n = 29), PVA particles (n = 5), Gelfoam (n = 5), coils (n = 4), PVA particles and coils (n = 3), glue and Gelfoam (n = 2), and glue and coils (n = 1). Outcomes assessed were cessation of bleeding, persistence or resolution of the AVM, complications, and pregnancy after embolization. These were assessed by chart, laboratory, and imaging reviews.

Results: A total of 375 embolization procedures were performed in 225 patients. Ninety patients required repeat embolization (14 patients underwent embolization on six occasions; 76 patients had two embolization procedures each) for recurrence of bleeding. A total of 240 procedures were performed on an elective basis, and 35 were performed on an emergent basis. The technical success rate of embolization was 100%. The clinical success rate was 92%: bleeding was controlled in 222 of 225 patients, and 3 patients underwent a hysterectomy. Sixty of the 225 patients had uneventful intrauterine pregnancies carried to term. The 210 patients who underwent successful embolization had no recurrence of bleeding at a median follow-up period of 53 months (range, 5–122 months) after treatment. Fifteen patients were eventually lost to follow-up. One minor complication (0.4%) of non–flow-limiting dissection of the internal iliac artery occurred.

Conclusions: UAE is a safe and effective treatment for patients with acquired AVMs. This procedure allows for preservation of uterine function with the possibility of future pregnancy and should be considered as a primary treatment option.