Uterine artery embolization may be discussed, but as recurrence can occur, AVfistula laparoscopic resection seems usefull. Furthermore, angiographic emboilzation does not compromise future pregnancy.

 see Mini invasive gynecol 2015, Patton et al

uterine AV malformation can be treated with uterine artery embolization or endoscopic resection, but in cases of severe bleeding Hysterectomy also needed.i have come across two cases,in one patient presented with Haemoperitoneum and shock required laparotomy and hysterectomy.another was having big pseudoaneurysm of anterior branch of Internal iliac artery required resection of aneurysm with hysterectomy.both cases published.attched

Article An interesting case of pseudoaneurysm of internal iliac arte...

second case report has presented with Hemoperitoneum and shock.but to preserve fertility and small fistulas can be well treated with arterial embolization or ressecion.recurrance can occure in such cases.

Article Uterine Arterio-venous Malformation with Hemoperitoneum

Dear Xue Du, dear all,

we had the opportunity to treat an uterine AV fistula of the left side surgically using da Vinci robotic surgery. Following exact localization by sonography including colour doppler left uterine artery has been prepared and supplying branches have been coagulated. Postoperative course was uneventful and there was no longer AV shunt present.

Due to the excellent blood supply of the uterus no impairment of uterine function may be expected which is also true for embolizeation. However, the decision which treatment appears to be best for a patient should be met individually  on the basis of the individual situation. For my oppinion, there is no best treatment that fits for all.

All the best and a healthy New Year!

Thanks all 

As Rainer said that the treatment should be met individually,we came across a young patient who has a strong desire to have another baby.we perpormed  selected uterine artery embolization successfully twice, but AV shunt present again.Now she was proscribed with oral contraceptives to prevent the irregular bleeding.Should we try  laproscopy to ressect the AV fistulas?

Dear Xue Du,

it depends on the individual risk situation; but fi you would expect relevant risks during the next pregnancy I would recommend to resect the AV fistulas before.

yours Rainer

i believe that AV Fistula resction should be proposed before a future pregnacy

We have treated 3 cases with hysteroscopic surgery. You can see the full article in my publications

regards

Thanks for all of you

Ailthough Ihave learned a lot from the publications of Luis and Rajshree and all your advices,I was regarated to say that the patient have been undergone the hysterectomy because of  recurrence of heavy vaginal bleeding.

regards for every one

Xue Du