Acquired uterine arteriovenous malformation: efficacy of the use of absorbable haemostatic gelatin in uterine artery embolisation.

Abstract

Purpose: To evaluate the efficacy and complications of absorbable haemostatic gelatin uterine artery embolisation for symptomatic acquired uterine arterio-venous malformation (UAVM).

Methods: All the adult female patients who had acute urogenital bleeding due to UAVM confirmed on ultrasound and received uterine artery embolisation (UAE) for UAVM in a tertiary institution between January 2000 and October 2024 were included. Patients who had UAE for other causes were excluded. Causes of UAVM, embolic agents used, procedural success, recurrent genital bleeding, and complications like pulmonary embolism and groin bleeding were recorded.

Results: Seven female patients (mean age: 34 years) with 8 UAE procedures were included, with three postpartum and four after miscarriages. The mean length of follow-up after UAE was 50 months. Absorbable gelatin was used in six patients, and polyvinyl alcohol (PVA) particles were used in one patient. 5/6 patients (83.3%) had successful UAE with absorbable haemostatic gelatin. There were no procedure-related complications, including pulmonary embolism and uterine infarcts. Only one patient required a repeated UAE 33 days later for recurrent vaginal bleeding, which required sodium tetradecyl sulphate injection and microcoils during embolisation.

Conclusion: Acquired UAVM is very rare but life-threatening. Absorbable haemostatic gelatin, a temporary embolic agent, appears safe and effective in treating UAVM with uterine preservation. It eliminates the potential risk of uterine infarction that might occur with permanent embolic agents.