Uterine arteriovenous fistula necessitating hysterectomy after two unsuccessful embolizations in an 18-year-old patient.

Uterine arteriovenous fistula is a rare, but potentially life-threatening condition that should be suspected in women of reproductive age with an unexplained vaginal bleeding. Uterine artery embolization, in contrast, is a safe and effective treatment for uterine arteriovenous fistula because it preserves the normal function of the uterus and the ovaries. The advantages of avoiding hysterectomy are clear, especially for young patients who want to preserve their reproductive function. Embolization failure is rare. When a uterine arteriovenous fistula reappears, it is necessary to perform subsequent embolization, especially in young patients, to treat the fistula effectively. The patient in this study had two unsuccessful embolizations, resulting in massive vaginal hemorrhage. This endangered the patient's life, and thus, a hysterectomy was performed, although the patient was infertile. Cases of unsuccessful embolizations, such as this, are unusual. Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.