Stage wise treatment of uterine arteriovenous malformation complicated by recurrent haemorrhage

Kungurtsev V.V., Cherkashov A.M., Sorokin V.G., Pavlova S.A., Zhadanova T.V.

Department of Roentgenosurgical Methods of Diagnosis and Treatment, Multimodality Medical Centre of the Bank of Russia, Moscow, Russia

Uterine arteriovenous malformation is a rarely encountered disease threatening with massive haemorrhage. The article describes a clinical case report regarding a 37-year-old woman presenting with this pathology and previously hospitalized twice with severe posthaemorrhagic complications at a 5-month interval due to refusal from timely hysterectomy. A vascular formation in the womb was detected at ultrasonography, however its pattern was identified only by computed tomography of small pelvis organs with intravenous contrasting. However, the complete picture of the architectonics of uterine arteriovenous malformation and extension of the pathology was obtained by selective subtraction angiography, making it possible not only to perform diagnosis but also, if necessary, to immediately perform selective embolization of the supplying vessels. Due to massive uterine bleeding on the background of womb malformation, the woman was twice subjected to roentgenoendovascular embolization of afferent vessels, with the achievement of persistent haemostasis. Hysterectomy was performed after stabilization of the state.

Thus, an extensive angiomatous uterine lesion accompanied by recurrent bleedings, along with roentgenoendovascular methods of treatment there is a need of additional surgical resection with the removal of the angiodysplasia focus.

KEY WORDS: arteriovenous malformation of the body of the womb, uterine bleeding, embolization of uterine arteries, computed tomography, hysterectomy.

Р. 144

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