Could Hypogastric Artery Ligation Be An Alternative To Artery Embolization For Managing Vaginal Bleeding? A Case Report.

Abstract

Uterine arteriovenous malformation (AVM) is an uncommon yet potentially life-threatening condition characterized by significant vaginal hemorrhage. Diagnosis can be established through various imaging modalities, including doppler ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), or pelvic angiography. The choice of treatment is influenced by several factors, including the patient's age, clinical symptoms, reproductive aspirations, and the size and anatomical location of the malformation. For symptomatic AVM in patients of reproductive age who wish to preserve fertility, uterine artery embolization (UAE) is considered the preferred therapeutic approach. This article is about the management of resistant vaginal bleeding after unsuccessful uterine artery embolization. This report presents a case of uterine AVM in a 32-year-old female who experienced abnormal vaginal bleeding following an induced abortion. The diagnosis of uterine AVM was confirmed via doppler ultrasonography. Although bilateral UAE was performed, the patient continued to experience significant vaginal bleeding. Following the unsuccessful embolization procedure, the patient was effectively managed through bilateral hypogastric artery ligation. Abnormal vaginal bleeding may be indicative of uterine AVM, particularly in individuals with a history of cesarean delivery, induced abortion, or dilation and curettage (D/C) procedures. While transcatheter UAE is generally an effective treatment, it may not succeed in all cases.