Delivery by Cesarean Section after Embolization for Vaginal Arteriovenous Malformation

Hasegawa, Tomohiko; Yamakawa, Yoshihiro; Ota, Satoshi; Kamei, Tetsuya; Tateno, Masaya

doi:10.1159/000106502

Cited by 2 publications

(2 citation statements)

References 12 publications

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“…Selective embolisation sometimes has to be carried out through two or more steps to avoid or reduce risks of complications, primarily acute ischaemia caused by occlusion of important anomalous arteries 10. Besides our case, we found two other case reports showing good results after embolisation of vulvar arterio-venous malformation by using a coil 11 12…”

Section: Discussionmentioning

confidence: 51%

Coiling of a vulvar arterio-venous malformation

Woude

Stegeman²,

Seelen³

2011

Case Reports

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SummaryThe authors report the case of a 13-year-old girl with a painful vulvar swelling and abnormal vaginal bleeding, increasing in size after trauma. With MRI (GE Signa HDx 1.5 Tesla), it is diagnosed as an arterio-venous malformation arising from the left superior femoral artery. It is treated by embolisation using a coil. benign soft-tissue tumours characterised by rapid postnatal growth followed by slow, invariable, spontaneous regression during childhood. 2 Vascular malformations are developmental errors which do not regress, and are composed of dysmorphic vessels with normal endothelial turnover. 2 3 The latter is subcategorised into arterial, venous (formerly 'cavernous haemangioma'), capillary, lymphatic or mixed types. 1 4 Vascular malformations can also be differentiated at the haemodynamic level between low-fl ow malformations, that include capillary and venous malformations, and high-fl ow malformations that include arterial malformations, arterio-venous fi stula and arterio-venous malformations. 1-2 5 The diagnosis of vascular malformations can be strongly suspected by careful history and physical examination. Venous malformations present as bluish, easily compressible non-pulsatile masses that increase in size with manoeuvres to increase venous pressure (Valsalva manoeuvre). 3 6 In case of vascular high fl ow malformations, pulsations are present. 7 Clinical symptoms include vulvar dysmenorrhoea, sexual dysfunction, swelling, pressure, discomfort, pain, abnormal vaginal bleeding and cosmetic problems. 2-3 8 Vascular malformations may be complicated by cutaneous ulceration and haemorrhage, limb hypertrophy or even high-output cardiac failure. 7 Venous malformations should be distinguished from vulvar varicosities ( table 1 ). 3 Vulvar varicosities are typical complications of pregnancy resulting from pelvic venous hypertension and they appear as a grapelike cluster of veins on the vulva. 3 6 While vulvar varicosities result from venous insuffi ciency or stasis, vascular malformations of the vulva are developmental errors, composed of dysmorphic vessels, and they do not regress. 6 Vascular malformations may undergo a rapid increase in size as a result of infection, thrombosis, trauma, surgical intervention and hormonal changes (as during puberty or in pregnancy). 2 5 7 For cases with progressive lesions in older women, a pathologic opinion is always necessary to rule out underlying malignancies. Regarding this point, biopsy may be indicated for superfi cial, localised and small lesions when clinical and imaging presentation is atypical. 2 Other differential diagnostic thoughts, besides varicosities and vulvar malignancies are outlined in table 2 . 2 Diagnosis of vascular malformations is primarily clinical and is confi rmed by ultrasound, colour Doppler ultrasound and MRI. 2 3 6-7 Ultrasounds reveal hypoechoic, heterogeneous lesions and yields reliable and adequate information regarding the nature and extend of a superfi cial malformation. 2-3 6 Colour Doppler analysis illustrates mono-or biphasi...

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Section: Discussionmentioning

confidence: 51%

Coiling of a vulvar arterio-venous malformation

Woude

Stegeman²,

Seelen³

2011

Case Reports

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“…However, in women who wish to preserve their fertility or cannot tolerate surgery, hysterectomy may not be desirable or feasible and uterine artery embolization is an acceptable treatment option. To date, we found 15 reports describing 19 pregnancies following uterine artery embolization for the treatment of arteriovenous malformation [3,5,[7][8][9][10][11][12][13][14][15][16][17][18][19] ( Table 1).…”

Section: Introductionmentioning

confidence: 99%

Fertility and pregnancy outcomes following uterine artery embolization (UAE) for uterine arteriovenous malformation (AVM)

Vilos

Vrijer

et al. 2009

Gynecol Surg

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A 19-year-old patient presented with intractable uterine bleeding, 11 weeks post-abortion. A pelvic ultrasound with Doppler and color imaging suggested a uterine arteriovenous malformation. Failing conservative therapies, the patient consented to uterine artery embolization (UAE). Two months later, she conceived and had an uneventful normal vaginal delivery at term. Since this is an extremely rare condition, allowing limited clinical exposure and experience, there may be an underlying reluctance by general practitioners to treat these cases with uterine artery embolization for fear of compromising future fertility and pregnancies. However, data from the 20 pregnancies embolized for uterine AVM cited in the present report and data from embolization for uterine fibroids indicate that such fears may be unfounded since pregnancy rates and outcomes may not be compromised after UAE.

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Delivery by Cesarean Section after Embolization for Vaginal Arteriovenous Malformation

Cited by 2 publications

References 12 publications

Coiling of a vulvar arterio-venous malformation

Coiling of a vulvar arterio-venous malformation

Fertility and pregnancy outcomes following uterine artery embolization (UAE) for uterine arteriovenous malformation (AVM)

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