Title

The Use of Interventional Endovascular Techniques Immediately before Hysterectomy for a Large Uterine Arteriovenous Malformation

Document Type

Journal Article

Publication Date

10-1-2018

Journal

Journal of Gynecologic Surgery

Volume

34

Issue

5

DOI

10.1089/gyn.2017.0144

Keywords

Arteriovenous malformation; Embolization; Emergency; Hemorrhage; Intervention

Abstract

© Copyright 2018, Mary Ann Liebert, Inc., publishers 2018. Background: Interventional radiologic techniques can be used to aid in the management of complex obstetric and gynecological disorders such as postpartum hemorrhage, fibroids, placenta accreta/percreta, arteriovenous malformations (AVMs) and other disorders associated with morbidity and mortality. Case: A 36-year-old female, with a history of 2 second-trimester spontaneous abortions, presented for surgical evaluation for a planned hysterectomy after pelvic magnetic resonance imaging showed a significant uterine AVM. Due to concern about hemorrhage during the surgery, bilateral iliac and bilateral ovarian arterial balloon catheters were placed intra-arterially, under fluoroscopic guidance, prior to surgery. After placement of the balloon catheters, with the patient under conscious sedation, she was transferred to the operating room and given general anesthesia. Diagnostic hysteroscopy showed that she had intrauterine scarring consistent with prior dilations and curettages. The balloons were inflated during surgical removal of the uterus and fallopian tubes. After the hysterectomy and salpingectomies, the balloon catheters were deflated. The patient was hemodynamically stable. The catheters were removed. The abdomen was suction irrigated and CO2 was suctioned out. The ports were removed, and the fascia and skin were closed. She underwent cystoscopy, which showed no injury to the bladder and ureters. Given her risk of potential intra-abdominal bleeding, she was then transferred to the intensive care unit for observation. Results: She was stable overnight and was transferred to the regular floor the following day. Her complete blood count in the morning was normal. Once she tolerated a regular diet, and ambulated and voided spontaneously, she was discharged from the hospital. Conclusions: As this clinical case illustrated, percutaneous, minimally invasive image-guided, interventional techniques may be used for patients with complex obstetric/gynecologic conditions. It is vital to recognize the importance of the multidisciplinary approach to the treatment of such patients.

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