Yamamoto Naoko, Koga Kaori, Akahane Masaaki, Wada-Hiraike Osamu, Fujii Tomoyuki, Osuga Yutaka
Department of Obstetrics and Gynecology, School of Medicine, The University of Tokyo, Tokyo, Japan.
J Obstet Gynaecol Res. 2015 Feb;41(2):314-8. doi: 10.1111/jog.12515. Epub 2014 Sep 17.
Arteriovenous fistula is any abnormal connection between an artery and a vein that bypasses the normal capillary bed and shunts arterial blood directly to the venous circulation. Uterine arteriovenous fistula (UAVF) is a potentially life-threatening condition by causing massive bleeding. This report describes a case of UAVF with massive hemorrhage. Prior to surgery, endovascular catheters for balloon occlusion were placed within bilateral uterine arteries. During surgery, the surgeon requested temporary balloon inflation for navigating and identifying inflow arteries. The balloon was kept inflated during the ligation of the vessels. Once ligation was completed, the balloon was deflated to confirm hemostasis. A total hysterectomy with removal of the UAVF was successfully achieved without significant blood loss. The fistula, in the resected specimen, was confirmed histologically with Elastica van Gieson staining. The preoperative placement of endovascular balloon-occlusion catheters should be considered when hysterectomy is planned where UAVF is located at the cardinal ligament.
动静脉瘘是指动脉与静脉之间的任何异常连接，这种连接绕过了正常的毛细血管床，将动脉血直接分流到静脉循环中。子宫动静脉瘘（UAVF）可导致大量出血，是一种潜在的危及生命的疾病。本报告描述了一例伴有大量出血的UAVF病例。手术前，在双侧子宫动脉内放置了用于球囊闭塞的血管内导管。手术过程中，外科医生要求临时充盈球囊以导航和识别流入动脉。在结扎血管时球囊保持充盈状态。一旦结扎完成，将球囊放气以确认止血情况。成功实施了全子宫切除术并切除了UAVF，术中无明显失血。在切除的标本中，通过弹性纤维染色在组织学上证实了瘘管的存在。当计划在主韧带处存在UAVF的情况下进行子宫切除术时，应考虑术前放置血管内球囊闭塞导管。
