Uterine artery ligation (UAL) is a surgical procedure that reduces blood flow to the uterus by blocking the uterine arteries. This procedure manages certain gynecological conditions, helping to control severe bleeding or shrink abnormal growths within the uterine tissue.
Conditions Treated by Uterine Artery Ligation
Uterine artery ligation addresses conditions involving excessive uterine bleeding or benign growths. One common indication is postpartum hemorrhage (PPH), which is severe bleeding after childbirth. In cases of PPH, especially when other treatments like medication or uterine massage are ineffective, UAL can be a life-saving measure. By reducing the blood flow to the uterus, it helps control the bleeding and allows the uterus to contract and recover.
UAL also manages symptomatic uterine fibroids and adenomyosis. Uterine fibroids are non-cancerous growths that develop in the uterus, while adenomyosis involves the growth of endometrial tissue into the muscular wall of the uterus. Both conditions can cause heavy menstrual bleeding, pelvic pain, and pressure symptoms. Reducing blood flow to the uterus through UAL helps to shrink these growths by depriving them of their primary blood supply. This reduction in size can alleviate symptoms, offering an alternative to more invasive procedures like hysterectomy, especially for individuals who wish to preserve their uterus.
The Surgical Process
Uterine artery ligation can be performed through several surgical approaches. Open abdominal surgery involves a larger incision in the abdomen to directly access the uterine arteries. Laparoscopic, or minimally invasive, surgery uses small incisions through which a camera and specialized instruments are inserted. This approach often results in less pain, shorter hospital stays, and quicker recovery compared to open surgery.
During the procedure, the surgeon identifies the uterine arteries, which are branches of the internal iliac artery, and carefully isolates them. The ligation itself involves blocking the arteries, typically using sutures, clips, or electrocautery. For instance, sutures made of absorbable material are commonly used to tie around the artery, effectively cutting off blood flow. In some laparoscopic procedures, vascular clips or bipolar devices may be used to occlude the vessels. The procedure can also sometimes be performed transvaginally, offering another minimally invasive option, particularly for postpartum hemorrhage. This technique involves accessing the uterine arteries through an incision in the anterior cervix. A gynecological surgeon typically performs surgical ligation, while an interventional radiologist may be involved in related procedures like uterine artery embolization, which also aims to reduce uterine blood flow but uses different techniques.
Post-Procedure Expectations and Considerations
Following uterine artery ligation, patients can expect a recovery period that varies based on the surgical approach used. Minimally invasive procedures allow for a quicker return to normal activities. Pain and some minor bleeding can be expected as the body recovers.
In the long term, UAL aims to resolve the original condition for which it was performed. For postpartum hemorrhage, the procedure has a high success rate in controlling bleeding, often between 81.5% and 96.5% when used alone or with subsequent hemostatic procedures. For uterine fibroids, patients often experience significant reductions in fibroid size and alleviation of symptoms like heavy bleeding and pain.
A common concern for many patients is the potential impact of UAL on future fertility and pregnancy outcomes. Current research suggests that uterine artery ligation generally does not compromise a woman’s ability to conceive or have a successful pregnancy. The uterine arteries may recanalize over time, and collateral circulation from other pelvic vessels can also supply blood to the uterus, preserving its function. While some studies have explored potential impacts on gestational age at birth or preterm birth, particularly with more extensive ligations, overall fertility and pregnancy rates appear comparable to those of women who did not undergo the procedure.