Arteriovenous Malformation Complicating Cesarean Scar Pregnancy: A Rare Case of Vaginal Bleeding Managed Successfully by Uterine Artery Embolization
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Abstract
Objective: Arteriovenous malformation (AVM) can occur in cesarean scar ectopic pregnancy. The presence of retained product of conception can pose a diagnostic dilemma and clinical presentation could be similar.
Case report: A 27 year old female presented with continuous vaginal bleeding for two and half months following dilatation and evacuation (D&E) done for cesarean scar pregnancy (CSP) of 10 weeks 4days period of gestation. Sonography with color Doppler revealed dilated tortuous vessels around the mass in lower uterine segment suggesting CSP with AVM. Digital subtraction angiography confirmed the diagnosis. Bilateral uterine artery embolization achieved complete devascularisation as confirmed on post intervention angiogram. Patient became symptom free since then.
Conclusion: Uterine artery embolization is an effective mode of treatment of AVM complicating CSP if future fertility is desired.
2. Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 2004; 23: 247–53.
3. Li X, Sun W, Chen L, Jin M, Zhang Z, Gao J, et al. Cesarean scar pregnancy combined with arteriovenous malformation successfully treated with transvaginal fertility-sparing surgery: a case report and literature review. Medicine (Baltimore) 2020; 99: e21432.
4. Huynh C, Ha TN, Hoang VT, Huynh PH. Acquired life-threatening uterine arteriovenous malformation treated by endovascular embolization. Radiol Case Rep 2020; 16: 241-5.
5. Timor-Tritsch IE, Haynes MC, Monteagudo A, Khatib N, Kovács S. Ultrasound diagnosis and management of acquired uterine enhanced myometrial vascularity/arteriovenous malformations. Am J Obstet Gynecol 2016; 214: 731.
6. Visvalingam G, Lee R, Tan, T, Tan H. An Unusual Case of Acquired Uterine Arteriovenous Malformation with Persistent Scar Ectopic Pregnancy Successfully Managed With Uterine Artery Embolization. Journal of Medical Cases. 2016; 7: 143-7.
7. Timmerman D, Wauters J, Van Calenbergh S, Van Schoubroeck D, Maleux G, Van Den Bosch T, et al. Color Doppler imaging is a valuable tool for the diagnosis and management of uterine vascular malformations. Ultrasound Obstet Gynecol 2003; 21: 570–7.
8. Aiyappan SK, Ranga U, Veeraiyan S. Doppler Sonography and 3D CT Angiography of Acquired Uterine Arteriovenous Malformations (AVMs): Report of Two Cases. J Clin Diagn Res 2014; 8: 187-9.
9. Molvi SN, Dash K, Rastogi H, Khanna SB. Transcatheter embolization of uterine arteriovenous malformation: report of 2 cases and review of literature.
J Minim Invasive Gynecol 2011; 18: 812-9.
10. Rygh AB, Greve OJ, Fjetland L, Berland JM, Eggebø TM. Arteriovenous malformation as a consequence of a scar pregnancy. Acta Obstet Gynecol Scand 2009; 88: 853–5.
11. Kim D, Moon NR, Lee SR, Won YD, Lee HJ, Park TC, et al. Acquired uterine arteriovenous malformation in a cesarean scar pregnancy. Taiwan J Obstet Gynecol 2013; 52: 590-2.
12. Kiyokawa S, Chiyoda T, Ueno K, Saotome K, Kim SH, Nakada S. Development of pseudoaneurysm in cesarean section scar pregnancy: a case report and literature review. J Med Ultrason (2001) 2018; 45: 357-62.
13. Akbayir O, Gedikbasi A, Akyol A, Ucar A, Saygi-Ozyurt S, Gulkilik A. Cesarean scar pregnancy: a rare cause of uterine arteriovenous malformation. J Clin Ultrasound. 2011; 39: 534-8.
14. Groszmann YS, Healy Murphy AL, Benacerraf BR. Diagnosis and management of patients with enhanced myometrial vascularity associated with retained products of conception. Ultrasound Obstet Gynecol 2018; 52: 396-9.
| Files | ||
| Issue | Vol 15, No 3 (September 2021) | |
| Section | Case Reports | |
| DOI | https://doi.org/10.18502/jfrh.v15i3.7140 | |
| Keywords | ||
| Cesarean Section Arteriovenous Malformations Uterine Artery Embolization | ||
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