Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 130  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::Related articles
 ::  Article in PDF (154 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Abstract
 ::  Case history
 ::  Discussion
 ::  References
 ::  Article Figures

 Article Access Statistics
    Viewed5857    
    Printed137    
    Emailed3    
    PDF Downloaded148    
    Comments [Add]    

Recommend this journal


 


 
CASE REPORT
Year : 2001  |  Volume : 47  |  Issue : 1  |  Page : 33-4

Angioembolisation in vaginal vascular malformation.


Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India. , India

Correspondence Address:
D N Srivastava
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
India
Login to access the Email id


PMID: 11590289

Get Permissions


 :: Abstract 

Vaginal arteriovenous malformations are rare entities and their most common presentation is vaginal haemorrhage. This case report describes a 22-year-old woman who presented at 20 weeks of gestation with slow growing soft and tender swelling at anterior vaginal wall. Diagnosis was confirmed as vaginal vascular malformation on contrast enhanced magnetic resonance imaging. The mass did not subside after delivery and patient developed dyspareunia. It was successfully treated by angioembolisation using polyvinyl alcohol particles. Angioembolisation being safe and effective should be the treatment of first choice for symptomatic vaginal vascular malformation.


Keywords: Adult, Arteriovenous Malformations, diagnosis,therapy,Case Report, Embolization, Therapeutic, Female, Human, Iliac Artery, Iliac Vein, Magnetic Resonance Imaging, Pregnancy, Treatment Outcome, Vaginal Diseases, diagnosis,therapy,


How to cite this article:
Srivastava D N, Saxena A K, Kriplani A, Agarwal N. Angioembolisation in vaginal vascular malformation. J Postgrad Med 2001;47:33

How to cite this URL:
Srivastava D N, Saxena A K, Kriplani A, Agarwal N. Angioembolisation in vaginal vascular malformation. J Postgrad Med [serial online] 2001 [cited 2014 Oct 25];47:33. Available from: http://www.jpgmonline.com/text.asp?2001/47/1/33/240


Vaginal vascular malformations are rare and can lead to life threatening complications. We report one such case whose diagnosis was made on magnetic resonance imaging (MRI) and was treated successfully by angio-embolisation.


  ::   Case history Top


A 22-year old multiparous woman (one full term normal delivery and two abortions) developed a slow growing soft and tender swelling at anterior vaginal wall at 20 weeks of gestation. The clinical diagnosis was arterio-venous malformation (AVM) which was confirmed on MRI. The contrast enhanced image showed a vascular mass [Figure - 1].

This mass kept on increasing in size and by the end of pregnancy it was very tender. There was no history of trauma. Antepartum embolisation was not considered for this patient. Large, palpable, pulsatile vaginal mass on clinical examination at 36 weeks prompted the decision of elective caesarean section to avoid possible rupture during vaginal delivery. No spontaneous regression occurred in post partum period and the patient developed dyspareunia and difficulty in micturition three months after delivery. Angio-graphic embolisation of the mass was done through right internal iliac branch by using 3 Fr infusion catheters (Tracker 325 Target Therapeutics, Fremont, CA, USA) and polyvinyl alcohol particles [Figures:2] and [Figure - 3]. The lesion disappeared in subsequent follow-up examinations and patient is symptom free on her last follow-up two years after embolisation.


  ::   Discussion Top


Vaginal vascular malformations can present with vaginal haemorrhage, congestive heart failure, postmenopausal bleeding and an asymptomatic mass. These lesions can be congenital or acquired.[1] The acquired lesions are believed to follow trauma or may arise after choriocarcinoma or other gynaecologic malignancies.[2] The incidence of vaginal AVM is so uncommon that only case reports are available.[3]

The diagnosis can rapidly be made and and extent of the lesion noted by showing vascular mass on transvaginal colour doppler ultrasound, angiography, computerised tomography or MRI. MRI findings which may be useful for differentiating AVM from other hypervascular tumours have recently been described and include phase shift artefact, paradoxical enhancement and enhanced flow voids[3]. Pelvic arteriography is helpful in delineating the main blood supply, the presence of collateral vessels, and venous shunting and pooling.

Symptomatic AVM needs treatment while asymptomatic AVM may be followed up with noninvasive sonography. However, it is important to correctly diagnose them since they may bleed during an unrelated procedure like uterine curettage. Angio-embolisation should be the treatment of choice in these symptomatic lesions as it appears to be safe and effective.[3] Recently a case of an embryonic cervical pregnancy diagnosed at ten weeks and associated with a large arteriovenous malformation treated with selective uterine artery embolisation has been reported. The mass had disappeared by the time of follow-up four months later.[4] Since there is a paucity of data on vaginal AVM and long-term follow up data is not available, it is difficult to assess long term benefits of embolisation therapy. Palmaz et al[5] in their review of one uterine AVM and four pelvic malformations with long term follow up, discovered that there is initially great success in treating congenital AVM. However, these lesions will often reccur, because they usually have excellent collateral circulation.

In our case, diagnosis was made on MRI and treated with angioembolisation. The patient continues to be asymptomatic after two years of follow up, emphasising the potential of angioembolisation as an alternative to surgery.

 
 :: References Top

1. Sholapurkar SL, Malhotra S, Dhall K, Kochhar S. Multiple congenital arteriovenous malformations with involvement of the vagina and profuse hemorrhage from vaginal ulcer. Gynecol Obstet Invest 1992; 33:126-128.  Back to cited text no. 1    
2.Hoffman MK, Meilstrup JW, Shackelford DP, Kaminski PF. Arterivenous malformations of the uterus: An uncommon cause of vaginal bleeding. Obstet Gynecol Surv 1997; 52:736-740.  Back to cited text no. 2    
3.Matsumoto K, Kurachi H, Murakami T, Narumi Y, Tsuda K, Yoshino K, et al. Vaginal arterivenous malformations: MR imaging. Abdom Imaging 1996; 21:554-556.  Back to cited text no. 3    
4.Su YN, Shih JC, Chiu WH, Lee CN, Cheng WF, Hsieh FJ. Cervical pregnancy: assessment with three dimensional power doppler imaging and successful management with selective uterine artery embolization. Ultrasound Obstet Gynecol 1999; 14:284-287.  Back to cited text no. 4    
5.Palmaz JC, Newton TH, Reuter SR, Bookstein JJ. Particulate intraarterial embolization in pelvic arteriovenous malformations. AJR Am J Roentgenology 1981; 137:117-122.   Back to cited text no. 5    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Medknow