title: Management of bleeding uterine arteriovenous malformation with bilateral uterine artery embolization.
abstract: OBJECTIVE
  To evaluate the technical feasibility and clinical outcome of bilateral uterine artery embolization (UAE) as a first-line therapeutic option for bleeding uterine arteriovenous malformation (AVM).
  
  
  METHODS
  Between 2002 and 2012, 19 patients were diagnosed with acquired uterine AVM clinically and through imaging studies. The clinical characteristics, angiographic features, technical success rate of embolization, procedure-related complications, imaging, and clinical follow-up data were assessed. Clinical success was defined as immediate symptomatic resolution with disappearance of vascular abnormality on subsequent imaging studies.
  
  
  RESULTS
  A total of 20 bilateral UAE, with or without embolization of extra-uterine feeders, were performed as the first-line treatment. Technical and clinical success rate was 90.0% (18/20) and 89.5% (17/19), respectively. Embolization was incomplete in two patients who had residual extra-uterine fine feeders to the AVM or a procedure- related complication (ruptured uterine artery); the former showed slow regression of the vascular malformation during the observation period, while the latter underwent a successful second bilateral UAE. Immediate clinical success was achieved in the remaining 17 patients after a single session and no recurrence of bleeding was found. Recovery to normal menstrual cycle was seen in all 17 patients with clinical success within one or two months, two of whom subsequently had uneventful intrauterine pregnancies carried to term.
  
  
  CONCLUSIONS
  Bilateral UAE is a safe and effective first-line therapeutic option for the management of bleeding uterine AVMs. However, incomplete embolization due to unembolizable feeders or difficult access into the uterine artery may lead to suboptimal treatment.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. jhshin@amc.seoul.kr.
authors.forename: Taehwan
authors.initials: T
authors.lastname: Kim
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Shin
authors.forename: Jinoo
authors.initials: J
authors.lastname: Kim
authors.forename: Hyun-Ki
authors.initials: HK
authors.lastname: Yoon
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.forename: Dong-Il
authors.initials: DI
authors.lastname: Gwon
authors.forename: Heechul
authors.initials: H
authors.lastname: Yang
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
mesh_terms: D000328:Adult; D000792:Angiography; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D012189:Retrospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*; D014592:Uterine Hemorrhage / Q000601:surgery*; D014599:Uterus / Q000098:blood supply; D055815:Young Adult
keywords: Uterine arteriovenous malformation; embolization