Vanderbilt University Medical Center Outcomes after uterine artery emoblization and other treatment modalities for uterine arteriovenous malformation Cynthia Arvizo, MD Vanderbilt University Medical Center November 15, 2017

Background Uterine arteriovenous malformations (AVM) constitute a rare, potentially life-threatening cause of abnormal uterine bleeding Uterine artery embolization is used often for treatment of uterine AVM No large-scale data regarding treatment or pregnancy outcomes

Our primary aim is to: Compare probability of reintervention between women with uterine AVM treated with UAE to treatment with other modalities

Study design Retrospective cohort

Study population Inclusion criteria Exclusion criteria Women 18 years or older with diagnostic imaging consistent with uterine AVM Exclusion criteria Incomplete or missing data on treatments Pregnant at time of diagnosis of uterine AVM Hysterectomy as primary treatment

Patients will be identified three ways: Diagnosis code “other AVM” and OB/GYN provider UAE CPT code 37210 Identification in the PACS system using the terms AVM Arteriovenous malformation AV malformation AV fistula Arteriovenous fistula

Outcomes Primary: Compare incidence of reintervention within one year between women treated with UAE and women treated with other modalities, excluding hysterectomy Secondary Mean time to re-intervention Pregnancy outcomes in women treated with UAE Rate of spontaneous pregnancy Rate of miscarriage, preterm and full term deliveries Rates of vaginal delivery and cesarean section Changes in diagnostic imaging after UAE Rate of resolution after UAE Doppler measurements of uterine AVM after UAE

Additional data Patient demographics Imaging modalities including Doppler measurements on ultrasound Presenting complaints (hemorrhage, irregular bleeding) Preceding events (pregnancy, uterine surgery) Timing from preceding event to presentation UAE procedure details Bilateral vs unilateral Particles vs coil Imaging after treatment Adverse events and complications related to treatment

Sample size In a previous study, median time to reintervention in the control group was 12 months With a relative risk of 2.339 and accrual time of 4 years, sample size is 32 in each group Power .80 and alpha 0.05

Planned statistical analysis Kaplan-Meier estimate for incidence Paired t-test for means of continuous variables

Budget $3000 for statistics

Items for discussion Limitations Recruitment period Patient identification If no repeat imaging, assuming reintervention is related to the uterine AVM Recruitment period

References Peitsidis P, Manolakos E, Tsekoura V, Kreienberg R, Schwentner L. Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review. Arch Gynecol Obstet. 2011;284(5):1137-1151.