A Fertility-Preserving Laparoscopic Management Combined With Hysteroscopy of Uterine Arteriovenous Malformation Followed by Uterine Arteries Embolization: A Case Report

The current study presented a fertility-preserving laparoscopic approach combined with hysteroscopy for the treatment of a uterine arteriovenous malformation (AVM) after a failed uterine artery embolization (UAE).

The patient was diagnosed with acquired uterine AVM and underwent a UAE, followed with the recurrence of massive vaginal bleeding. The computed tomography angiography (CTA) demonstrated AVM neovascularization and the patient profoundly desired to preserve her fertility.

The patient underwent a laparoscopic surgery combined with hysteroscopy during which the supply vessels of the AVM were obliterated and a 3-month GnRHa regimen was prescribed accordingly. The follow-up CTA was performed at postoperative day 3 and month 5. Both of the obtained images indicated the remission of the AVM. Thus, the patient remained asymptomatic during a 18-month follow-up after the operation.

In general, the laparoscopic obliteration of the supply vessels of the uterine AVM could provide an alternative to hysterectomy in patients whose embolization attempt failed and thus had a fertility-preserving desire.