Blood loss and power Doppler ultrasound characteristics of uterine artery blood flow after 2 levels of bilateral internal iliac artery ligation before extensive myomectomies

Abstract

Objective: To compare the blood loss and power Doppler ultrasonographic characteristics of uterine artery blood flow after 2 different techniques of internal iliac artery ligation prior to extensive myomectomy.

Study design: A randomized, double-blind study was conducted in a tertiary referral center. Either bilateral ligation of the anterior branch of the internal iliac artery (group I, n = 14) or ligation 2 cm proximal to its bifurcation (group II, n = 14) was performed. Intraoperative blood loss was calculated. Power Doppler ultrasonography and magnetic resonance angiography were used to evaluate blood flow in the uterine arteries.

Results: The mean number of leiomyomas excised was 9.5 +/- 3.4 in group I and 8.7 +/- 2.6 in group II (p = 0.5). The mean blood loss was similar in groups I and II (350 +/- 201 mL and 308 +/- 129 mL, respectively, p = 0.5). As compared to preoperative values, the decrease in the resistance index and mean arterial velocity was significant in both the right and left uterine arteries in group I. Only the decrease in mean arterial velocity in the right uterine artery was significant in group II.

Conclusion: Ligation of the anterior branch of the internal iliac artery provides a greater decrease in uterine artery resistance and velocity without causing any difference in blood loss as compared to main trunk ligation.