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Acquired Uterine Arteriovenous Malformation Definition in the Clinical Practice

To the Editor: We read with great interest the article by Tsai and colleagues. The authors describe a 31-year-old woman with a complete and large postmolar arteriovenous malformation (AVM). She was successfully treated with transarterial selective embolization for a long history of repeated excessive vaginal bleeding and anemia. We disagree with use of definition of AVM as complication of a gestational trophoblastic disease. The AVM is only congenital malformative vascular lesion and cannot be the complication of other uterine disease. The term malformation implies a congenital etiology. Amalformation is defined as a primary structural defect that results from a localized error of morphogenesis within the first 8 weeks after conception. The distinction of AVM into congenital and acquired is erroneous. In approximately 300 cases of AVMs reported in the English-language gynecologic and radiological literature, the histological documentation of the lesions is not reported. The definition of AVM should be avoided when histological documentation is not reported. In the radiological reports, the diagnosis of the lesion should be Bdescriptive[ of vascular uterine abnormality. In conclusion, in the clinical practice and in the scientific papers, we suggest the definition of Barteriovenous fistula[ or Barteriovenous shunt[ instead of acquired AVM.