A single-center experience with Uterine Artery Embolization (UAE) in 43 patients with Uterine Arteriovenous Fistulas (UAVFs)

Tuesday, April 1, 2025

4:21 PM – 4:30 PM CT

Location: Music City Center, 201 AB

Presenting Author(s)

Mira C. Malavia (she/her/hers)

Medical Student
University of Missouri-Kansas City School of Medicine, United States

Author/Co-author(s)

FD

Farnaz Dadrass, MD

IR/DR Resident
Mount Sinai Hospital, United States
EK

Emily Kim, None

High School Student
High School, United States
Edward Kim, MD (he/him/his)

Professor of Radiology and Surgery
Mount Sinai Health System, United States
Robert A. Lookstein, MD

Professor of Radiology and Surgery
Icahn School of Medicine at Mount Sinai, United States
Vivian Bishay, MD

Associate Professor
Icahn School of Medicine at Mount Sinai Hospital, United States
JV

Jenanan Vairavamurthy, MD

Assistant Professor of Radiology
Mount Sinai, United States
AF

Aaron M. Fischman, MD

Professor of Radiology and Surgery
Mount Sinai Health System, United States
Dan Shilo, MD

Assistant Professor
Mount Sinai, United States
RP

Rajesh I. Patel, MD

Assistant Professor of Radiology and Surgery
Icahn School of Medicine at Mount Sinai, United States
Scott Nowakowski, MD

Professor of Radiology and Surgery
Mount Sinai Health System, United States
Rahul S. Patel, MD, FSIR

Professor of Radiology and Surgery
Mount Sinai Medical Center, United States
KG

Kirema Garcia-Reyes, MD

Assistant Professor
Mount Sinai, United States

Purpose: Uterine arteriovenous fistulas (UAVFs) can cause sudden, massive hemorrhage due to abnormal communication between uterine arteries and veins, usually acquired through prior surgery or trauma such as dilation and curettage (D&C). Although UAVFs remain understudied, angiography is the gold standard for diagnosis, with uterine artery embolization (UAE) being a commonly used treatment. This study evaluated the technical and clinical success rates of UAE for treatment of UAVF, as well as long-term outcomes such as fertility preservation.

Materials and Methods:

Patients with UAVFs who underwent UAE at a single institution between 2009 and 2024 were included. All patients had a diagnosis of UAVF on ultrasound, CT, or MRI, confirmed by uterine angiography. Data on demographic characteristics, procedural details, technical, clinical outcomes, and complications were collected.

Results: Forty-three patients (mean age 34 ± 8 years) were included, 33 (77%) of whom presented with pelvic hemorrhage. Twenty-three (53%) of patients had been previously treated for a medical abortion and 31 (72%) had a history of pelvic intervention, including dilation and curettage (n=21), myomectomy (n=1), cesarean section (n=15), or forceps-assisted vaginal delivery (n=1). Preprocedural MRI was performed in 74% of patients (n=32). Radial access was utilized in 86% of cases (n=37), with femoral access in 14% (n=6) cases. Bilateral UAE was performed in 77% of patients (n=33), and unilateral UAE in 23% (n=10) patients. Embolic agents included glue (n=32), gelfoam (n=13), particles (n=5), coils (n=2), with combinations employed in 9 (21%) cases. All procedures were technically successful, without major complications. Symptom resolution was achieved in 40 (93%) patients. Over a mean follow-up of 87 weeks, 5 patients required repeat intervention for symptom recurrence (n=3) or persistent flow on imaging (n=2). Six patients successfully conceived and delivered healthy pregnancies following embolization.

Conclusion: UAE is a safe and effective treatment for UAVFs with high technical and clinical success rates. This study contributes to the limited body of research on UAVF treatment, allowing for future multi-institutional efforts to pool data and further evaluate efficacy, safety, and long-term fertility outcomes of UAE for UAVF.