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Resection of a Vulvar Arteriovenous Malformation in a Premenarchal Patient

Brotherton, Joy MD; Yazdany, Tajnoos MD

doi: 10.1097/AOG.0b013e3181cbd736
Case Reports

BACKGROUND: Arteriovenous malformation of the vulva is described in only a few case reports in the literature. Given the complex anatomy of the vulva, arteriovenous malformations in this location present a particularly challenging treatment dilemma.

CASE: An 11-year-old premenarchal girl with a large vulvar arteriovenous malformation was monitored for several years. After three episodes of bleeding, despite conservative management with embolization, she was taken urgently to the operating room for resection of the lesion. A multidisciplinary team participated in the 12-hour procedure. Several months after the initial surgery, the patient is without complaints and adjusting well. Labial reduction will be required once she is fully grown.

CONCLUSION: Arteriovenous malformations of the vulva require treatment before the onset of menarche because of the potential for massive hemorrhage. If first-line conservative treatment with embolization fails, a multidisciplinary team should be assembled for surgical treatment.

Arteriovenous malformations of the female genital tract are rare, congenital lesions that require a multidisciplinary approach to treatment.

From the Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California; and the Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, California.

Figures 2 through 5 are courtesy of Dax Guenter, MD, former fellow of the UCLA Division of Plastic Surgery.

The authors thank the Departments of Interventional Radiology, Vascular Surgery, Plastic Surgery, and Pediatrics at Harbor-UCLA Medical Center and the many physicians, nurses, and ancillary staff who participated in the care of this patient.

Corresponding author: Joy Brotherton, MD, FACOG, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Box 3, Torrance, CA 90509; e-mail:,

Financial Disclosure Dr. Brotherton is a consultant for Ethicon Endo-Surgery, Inc. (Cincinnati, OH), and has served on the clinical advisory board for the American Institute of Minimally Invasive Surgery (Las Vegas, NV). The other author did not report any potential conflicts of interest.

© 2010 The American College of Obstetricians and Gynecologists