Acquired Uterine Arteriovenous Fistulas After First-Trimester Pregnancy Loss: A Narrative Review with Case-Based Insights into Minimally Invasive Management

TL;DR

This paper reviews how uterine arteriovenous fistulas, which can occur after early pregnancy loss, are diagnosed and treated using minimally invasive methods to preserve fertility.

Contribution

The paper provides updated insights into diagnostic and therapeutic strategies for acquired uterine AVF/AVM, emphasizing fertility-preserving approaches.

Findings

Color Doppler ultrasonography is key for diagnosing uterine AVF/AVM by identifying high-velocity, low-resistance blood flow.

Uterine artery embolization and hysteroscopic techniques offer effective, uterus-preserving treatment options.

Repeat Doppler evaluations are important due to evolving vascular changes over time.

Abstract

Background and Objectives: Uterine arteriovenous fistulas (AVFs) and arteriovenous malformations (AVMs) are rare but potentially life-threatening vascular anomalies that most commonly develop after pregnancy-related uterine trauma, such as curettage or surgical evacuation. The widespread use of color Doppler ultrasonography has led to increased recognition of these lesions and a shift from hysterectomy toward fertility-preserving, minimally invasive management. This narrative review summarizes current evidence on acquired uterine AVF/AVM after early pregnancy loss, with particular emphasis on diagnostic challenges and contemporary therapeutic approaches, illustrated by representative clinical experience. Materials and Methods: A narrative review of the literature was conducted focusing on the pathophysiology, ultrasound and Doppler diagnostic criteria, interventional radiologic techniques, hysteroscopic management, and fertility outcomes in acquired uterine AVF/AVM. Illustrative clinical insights from anonymized post-abortion cases managed at our institution were incorporated solely to contextualize diagnostic and therapeutic considerations. Results: Color and spectral Doppler ultrasonography emerged as the diagnostic cornerstone, typically demonstrating serpiginous myometrial vessels with high-velocity, low-resistance turbulent flow, allowing for differentiation from retained products of conception. Uterine artery embolization showed high efficacy in achieving hemorrhage control, while hysteroscopic coagulation or resection represented an effective complementary or, in selected focal lesions, definitive treatment. Clinical experience highlighted that AVF-related vascularity may be evident early or may evolve over time, underscoring the importance of repeat Doppler evaluation in patients with persistent or recurrent bleeding. Conclusions: Acquired uterine AVF should be considered in women presenting with ongoing or recurrent uterine bleeding following aspiration abortion or curettage, even when initial Doppler findings are inconclusive. Individualized, minimally invasive strategies—often combining uterine artery embolization and hysteroscopic techniques—offer effective, uterus-preserving alternatives to hysterectomy.

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