Vascular uterine abnormalities: Comparison of imaging findings and clinical outcomes

• Non severe VUA have spontaneous favorable outcome without recurrence.
• Fertility is conserved after VUA even if embolization was performed.
• Recurrences are more often observed for severe VUA.
• Embolization must be proposed for anaemic patients or severe VUA on angiography.
• Recurrence occurs more often when a history of curettage is found.

ObjectiveTo retrospectively compare the imaging findings and the outcomes for patients with vascular uterine abnormalities (VUA) and to identify prognostic factors.Material and methodsBetween 2007 and 2012, 38 patients with vaginal bleeding and abnormal ultrasonographic (US) findings consistent with acquired VUA were consecutively included (mean age 31.6 years, range 19–62). Follow-up was 32 months in mean (1–78 months). Seventeen women (44.7%) started bleeding immediately after curettage, spontaneous miscarriage, trophoblastic disease, or section scars, with the remainder starting bleeding after 8 days to 2 years. All US, CT (n = 2), MR (n = 5) and angiographic (n = 26) images were reviewed and compared to medical reports in order to identify severe VUA requiring treatment, and predictive factors.ResultsNo information about severity was provided by US, MRI or CT. Twelve patients were successfully managed conservatively. Angiography identified 6 non-severe VUA, corresponding to an isolated uterine hyperemia, and 20 severe VUA, corresponding to an association of a nidus and early venous drainage. Recurrences were more often observed for severe VUA (p = 0.001). The hemoglobin level was significantly lower (below 11 g/L) in these cases (p = 0.004). Recurrences were significantly more frequently observed for patients with history of dilatation and curettage (p = 0.02). Hysterectomy was performed for three patients only (8%). Among the women who wished to have children, 14 (77.8%) were pregnant after 9 months in mean (range 2–23).ConclusionsRecurrence happens more frequently after curettage and in case of anemia or severe VUA findings on angiography, justifying adequate embolization for these patients.