Uterine Arteriovenous Malformations: Therapeutic Strategies and the Place of Hysteroscopy

Uterine arteriovenous malformations (UAVMs) are not common and are not well known. They are mainly manifested by hemorrhages that can be life-threatening. Their diagnosis is based mainly on ultrasound coupled with Doppler flow, as well as pelvic magnetic resonance imaging and angiography. In the absence of a consensus, and based on our experience, we discuss the place of hysteroscopy in the therapeutic strategy of UAVM. We reported 3 cases of UAVM, and we performed a review of the literature concerning the diagnosis and treatment of this pathology. We finally collected the advantages of the embolization-hysteroscopy sequence. In fact, the data suggest that hysteroscopy is a feasible and safe alternative treatment modality for UAVM. We believe that the resection of UAVM can be done under optimal conditions with a reduced risk of bleeding. Hysteroscopy would allow for optimal evaluation of the uterine cavity after treatment as well as the possibility of applying an anti-adhesive gel. In addition, the combination of hysteroscopy and embolization would require less healing time and shorter follow-up than embolization alone. It could also reduce the number of patients lost to follow-up.