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Case Reports
. 2014 Sep 2;3(8):2047981614545910.
doi: 10.1177/2047981614545910. eCollection 2014 Sep.

Successful treatment of acquired uterine arterial venous malformation using N-butyl-2-cyanoacrylate under balloon occlusion

Reiko Woodhams  1 , Go Ogasawara  1 , Kenichiro Ishida  2 , Kaoru Fujii  1 , Takuro Yamane  1 , Hiroshi Nishimaki  3 , Keiji Matsunaga  1 , Yusuke Inoue  1
Affiliations
Case Reports

Successful treatment of acquired uterine arterial venous malformation using N-butyl-2-cyanoacrylate under balloon occlusion

Reiko Woodhams et al. Acta Radiol Short Rep. .

Abstract

We present two cases of acquired uterine arterial venous malformation (AVM) which was diagnosed because of massive genital bleeding successfully treated with transcatheter arterial embolization (TAE), using N-butyl-2-cyanoacrylate (NBCA) under balloon occlusion. Balloon occlusion at the uterine artery was performed in both patients for diffuse distribution of NBCA in multiple feeding branches, as well as to the pseudoaneurysm, and for the prevention of NBCA reflux. In one of our patients, balloon occlusion of the draining vein was simultaneously performed to prevent NBCA migration through accompanying high-flow arteriovenous fistula (AVF). Doppler ultrasound at 6 months of both patients documented persistent complete occlusion of AVM. Complete and safe obliteration of acquired uterine AVM was accomplished using NBCA as embolic agent, under balloon occlusion at the communicating vessels of acquired uterine AVM.

Keywords: Acquired arteriovenous malformation; embolization; obstetrics.

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Figures

Fig. 1.
Fig. 1.
A 33-year-old woman with excessive genital bleeding 24 days after dilatation and curettage (D&C). (a) A CT image at arterial phase shows a uniform mass -like enhancement in the uterus which represents a pseudoaneurysm. (b) DSA from the left uterine artery shows multiple feeding arteries connecting to the pseudoaneurysm in the uterus. Direct draining from the pseudoaneurysm to the uterine vein is simultaneously demonstrated (arrow). (c) Diffuse distribution of NBCA is demonstrated on DSA after TAE with NBCA. Disappearance of AVM enhancement is confirmed.
Fig. 2.
Fig. 2.
A 30-year-old woman with repeat genital bleeding after threatened premature delivery. (a) A coronal T2W image of the uterus shows a high signal intensity mass lesion at the left side in the uterus (arrows). There is no signal void observed. (b) DSA from the left uterine artery shows a pseudoaneurysm, with two compartments, accepting blood flow from multiple feeding arteries. (c) Complete obliteration of AVM is demonstrated on DSA after TAE using NBCA under balloon occlusion of the left uterine artery.
See this image and copyright information in PMC

References

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