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- Title
Surgical Resection with Uterine Preservation in Uterine Arteriovenous Fistula: A Case Report and Literature Review.
- Authors
Nieto-Calvache, Albaro Jose; Campos-García, Clara Ivette; Granados-Sánchez, Ana Maria; Benavides-Calvache, Juan Pablo; Suso-Palau, Juan Pablo; Palacios-Jaraquemada, Jose Miguel; Escobar-Vidarte, Maria Fernanda
- Abstract
Background: Uterine arteriovenous fistula (UAVF), a rare condition, usually occurs in females of reproductive age and is commonly diagnosed in those with histories of myometrial traumas. UAVF is generally associated with severe bleeding. Treatment choices are usually limited to selective embolization or hysterectomy; however, other treatment options—such as surgical occlusion of the pelvic vessels, and, less frequently, en bloc resection of the lesion adjacent to the surrounding myometrium with uterine reconstruction—have also been reported. This article presents a case of conservative surgical management (CSM) of the condition, with details about a simple surgical technique and a literature review on this topic. Case: A 25-year-old female (gravida 1, molar 1), with a history of curettage 11 months before consultation, presented with severe vaginal bleeding and severe anemia. UAVF was diagnosed based on findings of Doppler ultrasound and magnetic resonance angiography. This patient was managed with complete surgical resection of the UAVF and uterine reconstruction. Results: Remarkably, this patient had a spontaneous pregnancy 15 months' postoperatively. Conclusions: A review of the literature identified only 5 reports on CSM, with the most frequently used treatments being hysterectomy and arterial embolization for UAVF. The former method eliminates all possibilities of future pregnancies, whereas the latter has a high failure rate for the first attempt. In cases of UAVF in which fertility preservation is preferred and expectant management is not possible, surgical resection of the affected area followed by uterine reconstruction represents a valid option for health care centers with experienced interdisciplinary teams.
- Subjects
DOPPLER ultrasonography; ANEMIA; ARTERIOVENOUS fistula; GYNECOLOGIC surgery; HYSTERECTOMY; PLASTIC surgery; UTERINE hemorrhage; UTERUS; THERAPEUTIC embolization; TREATMENT effectiveness; CURETTAGE; UTERINE artery; MAGNETIC resonance angiography; PREGNANCY
- Publication
Journal of Gynecologic Surgery, 2019, Vol 35, Issue 4, p264
- ISSN
1042-4067
- Publication type
Article
- DOI
10.1089/gyn.2018.0108