1. 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

2. 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

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

4. Study design
Retrospective cohort

5. 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

6. 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

8. 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

9. 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

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

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

12. Budget
$3000 for statistics

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

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