Uterine arteriovenous malformation

Last revised by Dr Daniel J Bell on 03 Aug 2021

Uterine arteriovenous malformations (UAVM) result from the formation of multiple arteriovenous fistulous communications within the uterus without an intervening capillary network.

Acquired UAVM disease is associated with conditions such as 4,7:

The presentation of uterine arteriovenous malformations varies. Uterine bleeding is the major presenting symptom, and it may be massive and life-threatening in young women. As these malformations are less common after menopause, post-menopausal bleeding is rarely seen. Congestive heart failure secondary to a vascular steal syndrome can be a less common clinical manifestation with a large UAVM.

A uterine arteriovenous malformation consists of a proliferation of vascular channels with fistula formation and an admixture of small, capillary-like channels. The size of these vessels can vary considerably. They are classified as congenital or acquired. The latter is more common and is often described as a uterine arteriovenous fistula.

Congenital UAVMs tend to have multiple feeding arteries, a central nidus (a tangle of vessels with histologic characteristics of both arteries and veins), and numerous large draining veins 6.

Acquired or traumatic UAVMs represent multiple small arteriovenous fistulas between intramural arterial branches and the myometrial venous plexus 7. They typically represent a single artery joining a simple vein.

Greyscale sonographic appearances can be non-specific with a range of manifestations including areas of subtle myometrial inhomogeneity, tubular spaces within the myometrium, an intramural uterine, endometrial or cervical mass like region or sometimes as prominent parametrial vessels 2. The extent of the mass effect is however minimal.

Typically shows serpiginous/tubular anechoic structures within the myometrium with low resistance (RI ~0.2-0.5), high-velocity flow pattern on color Doppler interrogation.

MRI allows one to confirm the diagnosis of uterine AVM non-invasively. Multiple serpentine flow-related signal voids are typically seen in the uterine wall, endometrial cavity, and parametrium on T1 and T2 weighted images. Contrast-enhanced dynamic MR angiography can depict complex serpentine abnormal vessels that enhance as intensely as normal vessels and show early venous return 4.

Transcatheter arterial embolization is an excellent treatment option in selected cases.

They were first described by G Dubreil and E Loubat in 1926 3.

On imaging appearances and if serum beta-HCG is elevated, consider:

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Cases and figures

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