Uterine arteries embolization for cesarean scar pregnancy with uterine arteriovenous fistula.

Uterine arteriovenous fistula is a vascular disease with a short circuit between the uterine arteries and veins. It is rare in clinical work with unclear incidence. Therefore, we aimed to summarize the disease characteristics of uterine arteriovenous fistula and provide a basis for clinical diagnosis and treatment. Herein, we present a case of cesarean scar pregnancy with uterine arteriovenous fistula in a 35-year-old woman, treated successfully with uterine artery embolization with preservation of her uterus. A preliminary diagnosis of cesarean scar pregnancy was made based on the patient's history and MRI. Bilateral uterine arteriography was performed to diagnose a cesarean scar pregnancy combined with uterine arteriovenous fistula bleeding. Hysteroscopic electroresection was performed for the uterine scar. Massive uterine bleeding occurred during the operation. There was still active bleeding after medication and intrauterine compression balloon hemostasis. Urgent bilateral uterine artery embolization was performed. After the operation, leprorelin 3.75 mg was given by intramuscular injection three times, followed by oral contraceptive drospirenone ethinylestradiol tablets, one tablet a day, to prevent recurrence of uterine arteriovenous fistula. After outpatient follow-up every month, the patient was discharged from the hospital for 3 months. Menstruation returned to normal after drug withdrawal, and no abnormal vaginal bleeding symptoms appeared. Uterine arteriovenous fistula should be considered in the clinical treatment of patients with abnormal vaginal bleeding who cannot be diagnosed clearly. Uterine arteriography is the definitive method, and after interventional treatment, drugs can be used to prevent recurrence and close follow-up.