Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang Key Laboratory of Precise Protection and Promotion of Fertility, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China.
Medicine (Baltimore). 2024 Aug 30;103(35):e39442. doi: 10.1097/MD.0000000000039442.
Uterine arteriovenous fistula (UAVF) is a rare vascular abnormality that can cause severe and potentially life-threatening hemorrhage. Uterine artery embolization is a common treatment that may affect ovarian and uterine perfusion and cause fertility problems. We herein report our experience treating 2 patients with UAVF who underwent resection after temporary occlusion of both internal iliac arteries.
Both patients presented with a large UAVF after incomplete miscarriages in the second trimester. Magnetic resonance imaging revealed a UAVF measuring 3.6 × 2.6 × 2.1 cm over the myometrium of the posterior uterine in case 1, and a UAVF of 7.1 × 4.1 × 4.5 cm was identified in case 2.
Uterine arteriovenous fistula, retained products of conception.
The patients underwent resection of UAVF with temporary occlusion of the internal iliac arteries and hysteroscopic removal of the retained products of conception.
Intraoperative bleeding were minimal. Neither patient exhibited abnormal uterine bleeding at the 6-month follow-up. Follow-up ultrasonography and magnetic resonance imaging showed normal uterine myometrium and endometrium and no residual disease.
UAVF resection after temporary occlusion of the internal iliac arteries is a promising treatment approach for UAVF. This technique can reduce intraoperative bleeding and remove the potential hemorrhage-related lesion while preserving fertility.
子宫动静脉瘘（Uterine arteriovenous fistula，UAVF）是一种罕见的血管异常，可导致严重且可能危及生命的出血。子宫动脉栓塞术是一种常见的治疗方法，可能会影响卵巢和子宫的灌注，并导致生育问题。我们在此报告 2 例因不完全性中期流产后出现 UAVF 而行双侧髂内动脉临时阻断后切除的患者的经验。
两例患者均在中期流产不完全后出现大的 UAVF。磁共振成像显示，1 例患者的子宫后肌层有一个 3.6×2.6×2.1cm 的 UAVF，2 例患者的 UAVF 大小为 7.1×4.1×4.5cm。
UAVF，妊娠物残留。
患者行 UAVF 切除术，同时行双侧髂内动脉临时阻断和宫腔镜下妊娠物残留清除术。
术中出血极少。2 例患者在 6 个月随访时均未出现异常子宫出血。随访超声和磁共振成像显示子宫肌层和子宫内膜正常，无残留病变。
双侧髂内动脉临时阻断后行 UAVF 切除术是治疗 UAVF 的一种有前途的方法。该技术可以减少术中出血，在保留生育能力的同时去除潜在的与出血相关的病变。
