title: Management of Intrauterine Arteriovenous Malformation (AVM) in 14 Patients by Sonographically Guided Tisseel Application.
abstract: AVMs are rare tumorous vascular lesions derived from placental tissue that may present with massive post-partum hemorrhage (PPH) causing potentially life-threatening anemic shock. Current treatment options include the embolization of uterine arteries and emergency postpartum hysterectomy. We present a new form of minimally invasive, highly specific sonographically guided treatment in the form of the application of a human fibrin sealant leading to the instant cease of blood loss.
  
  
  
  A management protocol was established and a case series of 14 patients is presented. Diagnosis by endovaginal color Doppler sonography is followed by the sonographically guided application of biological glue (TISSEEL®), thus allowing for super-selective occlusion of the feeding vessels.
  
  
  
  The procedure was technically successful in all 14 patients, 3 of whom (21 %) had a repeated procedure after 4 - 7 days. The mean age (yrs.) of the patients was 31 (25 - 40), the gravity was median 2 (1 - 5) and the parity was median 1 (0 - 4), the lowest Hb value was on average 9.35 ± 2.25 (5.2 - 14.2) g/dl, the lowest Ht was on average 30.82 ± 6.02 (18 - 41 %). Spectral Doppler analysis revealed an average of 80.71 ± 11.2 (66 - 115) cm/sec for the maximal detectable PSV. In the period of 4 - 55 months after treatment, 7 patients (50 %) had 8 successful pregnancies and 2 miscarriages.
  
  
  
  In PPH there is vital interest in timely diagnosis of the underlying cause, thus allowing fertility-sparing, minimally invasive and super-selective emergency treatment. In AVMs causing PPH, a positive impact on perinatal morbidity and mortality may be achieved by sonographically guided application of this biological glue.
authors.affiliation: Obstetrics & Gynecology, Semmelweis University Budapest, Asklepios Campus Hamburg, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bandura
authors.affiliation: Obstetrics & Gynecology, Asklepios Clinic Barmbek, Hamburg, Germany.
authors.forename: Tamina
authors.initials: T
authors.lastname: Rawnaq
authors.affiliation: Obstetrics & Gynecology, Landeskrankenhaus Feldkirch, Austria.
authors.forename: Annette
authors.initials: A
authors.lastname: Holzknecht
authors.affiliation: Obstetrics & Gynecology, Center for Prenatal Diagnosis and Fetal Genetics, Hamburg, Germany.
authors.forename: Emine
authors.initials: E
authors.lastname: Cetin
authors.affiliation: Obstetrics & Gynecology, Asklepios Clinic Barmbek, Hamburg, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Reemts
authors.affiliation: Obstetrics & Gynecology, Asklepios Pro-research, Hamburg, Germany.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Zoi
authors.affiliation: Obstetrics & Gynecology, Asklepios Clinic Barmbek, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schwärzler
mesh_terms: D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D015718:Fibrin Tissue Adhesive; D006801:Humans; D011247:Pregnancy; D018615:Ultrasonography, Doppler, Color; D055988:Uterine Artery / Q000000981:diagnostic imaging; D014591:Uterine Diseases / Q000000981:diagnostic imaging / Q000628:therapy
chemical_list: D015718:Fibrin Tissue Adhesive