Embolisation of an acquired uterine arteriovenous malformation

A G5P2+2 woman in her 30s presented to hospital with per vaginum (PV) bleeding, approximately 2 weeks post electric vacuum aspiration (EVA) for retained products of conception. Ultrasound and MRI demonstrated a large vascular myometrial lesion, suggestive of a uterine arteriovenous malformation (UAVM). She underwent digital subtraction angiography (DSA) with interventional radiology and simultaneous uterine artery embolisation (UAE). She represented 2 weeks later with recurrent PV bleeding and anaemia. She underwent repeat DSA, demonstrating persistent UAVM, and a repeat embolisation was performed. Symptoms resolved following the second embolisation, and a repeat MRI performed 12 weeks later demonstrated complete resolution of the UAVM.Although UAVMs are rare lesions, they can cause significant haemorrhage and morbidity. The presence of UAVM should particularly be considered after uterine intervention such as EVA or caesarean section.UAE is a safe and effective therapy, which preserves fertility.