title: Embolization of uterine arteriovenous malformations in patients with gestational trophoblastic tumors: a review of patients at Charing Cross Hospital, 2000-2009.
abstract: OBJECTIVE
  To review the indications, efficacy and follow-up for gestational trophoblastic tumor (GTT) patients treated for uterine arteriovenous vascular malformations (AVMs) and bleeding vaginal metastases with modern polyvinyl alcohol particle (PVA)-based radiological embolization.
  
  
  METHODS
  GTT patients undergoing embolization were identified from the Charing Cross Hospital database. The patients' records were assessed for indication, technique used, primary and overall success in controlling bleeding, complications and subsequent pregnancy outcome.
  
  
  RESULTS
  During the period 2000-2009, 19 patients were treated for persistent or life-threatening bleeding by PVA-based uterine artery embolization performed via the femoral artery approach. Embolization resulted in control of hemorrhage in 18 of the 19 patients; 15 achieved control after the first procedure, with only 4 patients requiring a second procedure. In 1 case surgical intervention was required to control bleeding. The most frequent morbidity from the procedure was pelvic pain, requiring opiate administration; there were no other regular complications. The fertility outcome for these 19 patients indicates that 9 women have gone on to deliver a total of 12 healthy infants postembolization.
  
  
  CONCLUSIONS
  For GTT patients with heavy bleeding from AVMs, uterine artery embolization is a safe and effective treatment with low short-term toxicity and no obvious detrimental effect on future fertility.
authors: Department of Medical Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
authors: Sophie
authors: S
authors: McGrath
authors: Victoria
authors: V
authors: Harding
authors: Adrian K P
authors: AK
authors: Lim
authors: Nick
authors: N
authors: Burfitt
authors: Michael J
authors: MJ
authors: Seckl
authors: Philip
authors: P
authors: Savage
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000209:etiology / Q000628:therapy*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000150:complications* / Q000628:therapy; D006801:Humans; D017699:Pelvic Pain / Q000209:etiology; D011142:Polyvinyl Alcohol; D011247:Pregnancy; D018873:Pregnancy Rate; D015641:Radiography, Interventional; D055357:Uterine Artery Embolization; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy*; D014594:Uterine Neoplasms / Q000150:complications* / Q000628:therapy; D055815:Young Adult
chemical_list: D011142:Polyvinyl Alcohol