REGULAR CONTENT
Final ID
410
Type
Original Scientific Research-Oral or Pos
Authors
J Qian1, M Neimark1, J Cynamon1, W Malouf2
Institutions
1Montefiore Medical Center, Bronx, NY, 2Albert Einstein College of Medicine, Bronx, NY
Purpose
Uterine AVM is a rare gynecologic condition that may present with life threatening vaginal bleeding. There are case reports of endovascular treatment of uterine AVM by transcatheter arterial embolization of the uterine arteries. However, difficult canalization or inadequate embolic agent deposition within the AVM may compromise the effectiveness of this type of treatment. We propose that percutaneous treatment with direct puncture is a viable treatment approach in conjunction with the endovascular method. We present 2 cases of direct AVM puncture after initial endovascular treatment was attempted. We discuss the utility of cone beam CT in assessing the success of the treatment.
Materials & Methods
We present two cases where patients who underwent direct percutaneous embolization of uterine AVM. One patient had a recent spontaneous delivery and the other had a recently terminated pregnancy. Both had heavy vaginal bleed prior to the procedures, one required blood transfusion. Transvaginal ultrasound was performed in making the diagnosis of uterine AVM. The patients received initial treatment of uterine artery embolization. Percutaneous punctures were utilized when there was clinical or angiographic evidence of lack of adequate treatment. We used digital subtraction angiogram (DSA) as the roadmap to perform the puncture to the nidus using a 21 gauge needle under direct fluoroscopic guidance. Onyx embolic agent was used to obliterate the AVM nidus through the 21 gauge needle.
Results
No complications occurred. Post procedure cone beam CT demonstrated complete abolishment of uterine AVM. Both patients achieved complete resolution of vaginal hemorrhage at the follow-up appointment as outpatient. Cone beam CT correlated with the ultrasound findings.
Conclusions
We propose that direct puncture of uterine AVM using a 21g needle and embolization using liquid embolic agent is a safe and viable adjunct approach when endovascular approaches fail to achieve adequate bleeding control. Pre-procedure transvaginal ultrasound has its utility in making the diagnosis. We conclude that the application of cone beam CT in the embolization of bleeding uterine AVM is a useful addition to the imaging guided treatment approach.
Final ID
410
Type
Original Scientific Research-Oral or Pos
Authors
J Qian1, M Neimark1, J Cynamon1, W Malouf2
Institutions
1Montefiore Medical Center, Bronx, NY, 2Albert Einstein College of Medicine, Bronx, NY
Purpose
Uterine AVM is a rare gynecologic condition that may present with life threatening vaginal bleeding. There are case reports of endovascular treatment of uterine AVM by transcatheter arterial embolization of the uterine arteries. However, difficult canalization or inadequate embolic agent deposition within the AVM may compromise the effectiveness of this type of treatment. We propose that percutaneous treatment with direct puncture is a viable treatment approach in conjunction with the endovascular method. We present 2 cases of direct AVM puncture after initial endovascular treatment was attempted. We discuss the utility of cone beam CT in assessing the success of the treatment.
Materials & Methods
We present two cases where patients who underwent direct percutaneous embolization of uterine AVM. One patient had a recent spontaneous delivery and the other had a recently terminated pregnancy. Both had heavy vaginal bleed prior to the procedures, one required blood transfusion. Transvaginal ultrasound was performed in making the diagnosis of uterine AVM. The patients received initial treatment of uterine artery embolization. Percutaneous punctures were utilized when there was clinical or angiographic evidence of lack of adequate treatment. We used digital subtraction angiogram (DSA) as the roadmap to perform the puncture to the nidus using a 21 gauge needle under direct fluoroscopic guidance. Onyx embolic agent was used to obliterate the AVM nidus through the 21 gauge needle.
Results
No complications occurred. Post procedure cone beam CT demonstrated complete abolishment of uterine AVM. Both patients achieved complete resolution of vaginal hemorrhage at the follow-up appointment as outpatient. Cone beam CT correlated with the ultrasound findings.
Conclusions
We propose that direct puncture of uterine AVM using a 21g needle and embolization using liquid embolic agent is a safe and viable adjunct approach when endovascular approaches fail to achieve adequate bleeding control. Pre-procedure transvaginal ultrasound has its utility in making the diagnosis. We conclude that the application of cone beam CT in the embolization of bleeding uterine AVM is a useful addition to the imaging guided treatment approach.