Uterine arteriovenous malformations (AVMs) are broadly classified as congenital or acquired.1 Congenital AVMs are rare, whereas acquired or traumatic AVMs are being increasingly diagnosed. Congenital uterine AVMs result from abnormal embryologic development of primitive vascular structures, which result in multiple abnormal communications between arteries and veins.
Congenital AVMs 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.Conversely, acquired or traumatic uterine AVMs represent multiple small arteriovenous fistulas between intramural arterial branches and the myometrial venous plexus.Acquired AVMs tend to have single/bilateral uterine artery feeders without an extrauterine arterial supply and do not have a characteristic nidus.
Patient history is critical in distinguishing congenital from acquired AVMs because the imaging features of both may be quite similar. Acquired uterine AVMs are usually traumatic, resulting from prior dilation and curettage (D&C), therapeutic abortion, uterine surgery, or direct uterine trauma.6-8 Less commonly, endometrial carcinoma, cervical carcinoma, and gestational trophoblastic disease (GTD) have been implicated as causes of acquired uterine AVMs.
Traumatic uterine AVMs usually present with intermittent but torrential vaginal bleeding. This pattern of bleeding is suggestive of arterial hemorrhage. Rapid recognition that a traumatic uterine AVM is the cause of bleeding is critical to patient treatment. In this clinical situation, uterine instrumentation (D&C) may aggravate the condition. Traditionally, uterine AVMs have been treated by uterine artery ligation or hysterectomy. Today, transcatheter arterial embolization (TAE) is an alternative minimally invasive treatment option with potential to preserve fertility. The purpose of this study was to describe the sonographic features of uterine AVMs and (2) to describe the role and clinical outcome after TAE of symptomatic uterine AVMs.