Abstract
An: 2015, Nr.2, Articol Nr. 17
Title: 

COLLATERAL CIRCULATION IN THE FEMALE PELVIS AND THE EXTRAUTERINE ANASTOMOSIS SYSTEM

Authors: 

      Elvira Brătilă, C.B. Coroleucă, C.A. Coroleucă - University of Medicine and Pharmacy “Carol Davila” Bucharest; Emergency Clinical Hospital “Sf. Pantelimon”, Clinical Obstetrics and Gynecology
      C.P. Brătilă - Euroclinical Hospital “Regina Maria”, Bucharest
      COLLATERAL CIRCULATION IN THE FEMALE PELVIS AND THE EXTRAUTERINE ANASTOMOSIS SYSTEM (Abstract): Hypogastric artery ligation is a method to control bleeding during obstetrical or gynecological surgery that should be included in the portfolio of each gynecologic surgeon. In literature there are conflicting data regarding the effectiveness of this maneuver. The explanation for the failure of this technique can be explained by the system of anastomoses between uterine and vaginal arteries. In the past, it was thought that hypogastric artery ligation is equivalent traffic disruption in the territory served. If the procedure is performed correctly, short and long term morbidity is low. Aim: This paper aims to present the anatomical landmarks and collateral circulation in the female pelvis in order to determine the effectiveness of bilateral hypogastric artery ligation. Methods: We analyzed the articles published in professional journals to observe the efficiency of hypogastric artery ligation and its impact on fertility. Results: The study of uterine blood supply and collateral circulation has stagnated for many years. There are three arterial pedicles which provide vasculature to the lower portion of the uterus: uterine artery, the artery cervical and vaginal arteries. Because of the anastomosis network present at this level the distal portion of the hypogastric artery is never emptied of blood flow. Conclusions: The anastomosis system between uterine and vaginal arteries explains maneuver failure, hemodynamic disorders and complications that can occur after bilateral ligation hypogastric artery. Collateral circulation becomes operational in 45-60 minutes after ligation. The data described in the literature presents a success rate which varies between 48 and 85%. It is a technique that allows preservation of fertility but there are a small number of case studies showing the evolution of the pregnancies obtained after ligation bilateral hypogastric artery.
Key words: HYPOGASTRIC ARTERY LIGATION, COLLATERAL CIRCULATION, ANASTOMOSIS, PREGNANCY
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