Uterine Arteriovenous Fistula:Rare Cause of Vaginal Bleeding and Experience from 14 Case Series in a Single Center

Background: This study aimed to summarize the characteristics of uterine arteriovenous fistul for proper treatment.Methods: This was a retrospective study of fourteen women diagnosed with uterine arteriovenous fistul and eventually proved by pelvic angiography at our department,. Results: Six women presented with late postpartum hemorrhage and the other seven had abnormal uterine bleeding while only one was asymptomatic.The majority of them had uterine manipulation with the most common being repeated dilation and curettage but the time interval ranged from more than ten days to months even several years. they could originate from ovarian artery or internal iliac artery in rare cases and even some cases showed uterine artery- ovarian vein fistul. Most of them had a good outcome with bleeding resolved or mild bleeding after arterial embolization with controllable fever and pain, and only three cases had surgery unsuitable for embolization or formation of traffic branch after embolization.Conclusions: uterine arteriovenous fistul were rare but easy to be diagnosed with characteristic ultrasound findings along medical history such as D&G and feature of vaginal bleeding. A successful treatment for artery embolization was based on careful evaluated vessels mapped by angiography while a comprehensive assessment with color and spectral flow Doppler was very necessary to exclude retained products of conception or placenta and avert unnecessary D&G after embolization. Surgical therapy was the last choice in women difficult to embolism or failed with UAE.