title: Temporary balloon occlusion of the uterine arteries to control hemorrhage during hysterectomy in a case of uterine arteriovenous fistula.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Kaori
authors.initials: K
authors.lastname: Koga
authors.forename: Masaaki
authors.initials: M
authors.lastname: Akahane
authors.forename: Osamu
authors.initials: O
authors.lastname: Wada-Hiraike
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujii
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Osuga
mesh_terms: D001164:Arteriovenous Fistula / Q000150:complications / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D055988:Uterine Artery / Q000601:surgery*; D058738:Uterine Balloon Tamponade; D014592:Uterine Hemorrhage / Q000209:etiology / Q000517:prevention & control*
keywords: Elastica van Gieson stain; balloon occlusion; histology; hysterectomy; uterine arteriovenous fistula