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Temporary Uterine Artery Embolization Followed by Hysteroscopy to Treat a Case of Acquired Uterine Arteriovenous Malformation (UAVM): Case Report with Systematic Literature Review

Author(s): Catena U, Romito I, Mastrovito S, Iacobelli V, Campolo F, Ianieri MM, Cina A, Scambia G

Objective: This paper provides information about conservative surgery to correct uterine arteriovenous malformations (UAVMs). The main objectives are to review the current literature on this subject and to share our very interesting and challenging case of UAVM. Our innovative surgical approach consisted in a combined method with temporary uterine artery embolization (UAE) plus hysteroscopic treatment.

Materials and Methods: A search of MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library was performed. Any type of study has been considered including case reports. We identify articles published from the inception to July 2019. Three hundred sixty-three articles were identified: 286 articles were excluded for any reason. Overall, 77 articles were incorporated for further assessment.

Results: Four surgical techniques have been employed to treat 125 cases of UAVMs: uterine artery embolization (UAE) (69.9%),dilatation and curettage (D&C) (10.4%), operative hysteroscopy (14.4%), uterine artery ligation (4%). Two patients (1.6%) underwent combined approach. Failed procedures which required a new treatment were twenty-one (16.8%). Forty-five pregnancies after surgical conservative management of UAVMs were reported.

Conclusion: UAVM is a rare condition. In literature, there is no gold standard of treatment. For young women who wish to preserve fertility, a conservative surgical management should be recommended. As in our case, using a resorbable agent to perform UAE permitted a normal restoration of the flow in the uterine artery after the hysteroscopic resection.

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