Rabei Rana, Garcia-Reyes Kirema, Poder Liina, Strachowski Loretta, Feldstein Vickie, Ito Traci, Lager Jeannette C, Kohi Maureen Pearl, Lehrman Evan
Department of Interventional Radiology, University of California San Francisco, San Francisco, California.
Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
J Vasc Interv Radiol. 2025 Sep;36(9):1395-1400. doi: 10.1016/j.jvir.2025.05.013. Epub 2025 May 15.
To determine the safety and effectiveness of ultrasound (US)-guided direct puncture and embolization of acquired uterine arteriovenous fistulae (UAVFs) with ethylene vinyl alcohol copolymer (EVOH) and to determine its impact on subsequent fertility.
A retrospective review of consecutive patients treated for UAVFs with life-threatening hemorrhage from July 2015 to April 2022 was performed. Patient demographics, imaging studies, procedural reports and follow-up clinic notes were reviewed. A total of 7 patients were included; median age was 32 years (range, 22-38 years). All patients had a history of uterine instrumentation and presented with vaginal bleeding and presumed UAVF, confirmed by US or magnetic resonance (MR) imaging. Two (29%) had previously undergone proximal transarterial uterine artery embolization but had recurrent bleeding. US-guided direct UAVF puncture was performed by a transabdominal (n = 2) or transvaginal (n = 5) approach with injection of EVOH in all patients. Technical success was defined as resolution of UAVF on intraprocedural angiography and US and follow-up MR imaging. Clinical success was defined as resolution of the bleeding without recurrence or need for subsequent embolization or hysterectomy.
Median follow-up duration was 158 days (range, 7-2,061 days). Technical success was 100%. Clinical success was 100% with resolution of bleeding in all patients. No adverse events related to the embolization procedure were noted. One patient was lost to follow-up within a month of the procedure and, therefore, excluded from clinical analysis. Of the remaining 6 patients, 3 had successful childbirths after the embolization procedure, and 1 was pregnant at the time of data collection. One patient had an ectopic pregnancy after the procedure.
US-guided direct puncture and EVOH embolization appears to be a safe and effective option for management of acquired UAVFs in a small cohort of patients, avoiding hysterectomy and preserving the option of fertility in young women.
