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Combined utero ovarian artery ligation (Quadruple ligation) was done in one patient, and two patients responded to bilateral internal iliac artery ligation (BIIL) or hypogastric artery ligation (HAL).
The ovarian artery, median sacral artery, external iliac artery, internal iliac artery and its branches are important structures of pelvic retroperitoneal vasculature (Figure 5).
MRA revealed two suspected feeding vessels: a branch off the right ovarian artery parasitized to the uterine arcuate artery (Figure 4) and a branch off the right uterine artery parasitized to the uterine arcuate and radial arteries (Figure 5).
Inadequate embolisation of a PA due to extrauterine feeding arteries, such as the internal pudendal artery, ovarian artery, inferior epigastric artery, or contralateral uterine artery can lead to embolisation failure.
Occluding the utero-ovarian ligaments with bulldog clamps to control collateral blood flow from the ovarian artery has been described, but the clamps can tear these often enlarged and fragile uterine veins during manipulation of the uterus.
When the uterine artery is absent, it is often replaced by the ipsilateral ovarian artery or may be replaced by small arterial pelvic branches (23).
Embolization of the abnormal vessels from the ovarian artery was performed using 0.8 cc of n-butyl-2-cyanoacylate (NBCA) lipiodol (NBCA: lipiodol = 1:4) under arterial flow control by occlusion balloon (Figure 2(b)).
Color Doppler ultrasound scanning is able to disclose the dilation and distortion of the uterine artery and peritumoral arterial branches, vascular dysplasia, as well as abnormally rich intratumoral and peritumoral blood flows.14 By reducing blood flow, UAE only induces UF necrosis other than massive necrosis of the uterus, mainly because UF cells cannot endure ischemia and hypoxia as effectively as normal uterine smooth muscle cells do owing to active division.15 In the meantime, the uterus escapes from massive necrosis due to blood supply from abundant pelvic collateral circulation and vascular network, together with the traffic branch of iliolumbar artery, ovarian artery, vaginal artery and sacral artery.
After complete hemostasis and sectioning of the left ovarian artery and vein, animals were repositioned in a supine recumbent position and the area close to the suspensory ovarian ligament was grasped using the Kelly forceps.
Doctors discovered that Wei's ovarian artery had been nicked during the retrieval process and her abdomen had filled with blood.