Introduction: A cesarean scar pregnancy (CSP), when combined with an arteriovenous malformation (AVM), is a rare, but potentially life-threatening condition that may be associated with uncontrolled hemorrhage. Hysterectomy is indicated when conservative treatment fails. Preservation of fertility is challenging.
Patient concerns: We reported a 33-year-old woman with a CSP combined with an AVM who failed methotrexate administration as conservative treatment.
Diagnoses: A CSP combined with an AVM was diagnosed via three-dimensional color Doppler angiogram and magnetic resonance imaging.
Interventions: Transvaginal removal of the ectopic gestation and repair of the uterine defect was performed without incident.
Outcomes: The fertility of the patient was preserved and hysterectomy was avoided.
Conclusion: Transvaginal fertility-sparing surgery may be successfully performed to prevent hysterectomy when conservative treatment fails in patients with a CSP combined with an AVM.