Human uterine vasculature with respect to uterus transplantation: A comprehensive review

Abstract

Due to the novelty of uterus transplantation, data on preferable inflow and outflow of the graft are limited. This paper reviews the technique, type of vessels and the outcome. A systematic search of the PubMed database was conducted. We extracted and analyzed data on the arteries and veins utilized, types of anastomosis, types of donors, complications and the outcome. Thirty eight sources reported 51 human uterine transplantations, 10 graft thromboses and 25 live births. Inflow was established with two uterine arteries (UA) with/without the anterior division of the internal iliac artery in 62% (n = 31) of cases, two UA arteries with a segment/patch of the internal iliac artery in 34% (n = 17) of cases or two UA with a conduit in 4% of cases (n = 2). Both cases with a conduit developed thrombosis (n = 2). Arterial thrombosis/ischemia developed in 8 of the 51 cases. In 50% of cases with arterial thrombosis, atherosclerosis was identified as a possible cause. Outflow was established by two internal iliac veins with patches/segments in 27.5% of cases (n = 14) followed by two utero-ovarian veins in 25.5% (n = 13). Venous thrombosis occurred in 3 of the 51 cases. Uterine arteries with/without anterior division of the internal iliac artery were the most frequent arteries used for inflow and produced the highest patency rate. The presence of atherosclerosis and complex arterial reconstruction was associated with a high rate of arterial thrombosis. None of the veins utilized in the procedures appeared to be superior. There are insufficient data to draw a definite conclusion.

Evolution and Transformation of Uterine Transplantation: A Systematic Review of Surgical Techniques and Outcomes

“…1 ). 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 From 40 articles included, 16 articles were case reports (independent), 5 articles were case reports part of an observational study, 2 were commentaries or reflections, 13 were prospective observational studies reporting outcomes of single-arm clinical trials, and 4 were reviews (see Table, Supplemental Digital Content S3 [available in the online version] which displays an overview of the included patients).…”

“…Using the schematic diagram detailed by Kristek et al ( Fig. 2 ), 28 the arterial anastomoses were accomplished with two uterine arteries (UA) with/without the anterior division of the internal iliac artery (IIA) in 36 cases (56.25%), with two UA with a segment or patch of the IIA in 24 cases (37.5%), and two UA with a conduit or a reconstruction in two cases (3.12%). Arterial anastomoses were end to side (E-S) in 58 cases (90.6%) and were anastomosed to the external iliac artery (EIA) in 59 cases (92.18%; Table 3 ).…”

“…In these cases which represent the majority of the donors for UTx, an adequate surgical technique for anastomosis of the arterial component (diameter of proximal UA: 1.59 ± 0.13 mm), even with microsurgical skills, may be necessary to avoid using a patch or segment of the IIA, in turn reducing morbidity of LDs (claudication). 28 31 65 66…”

“…Using the schematic diagram detailed by Kristek et al (►Fig. 2),28 the arterial anastomoses were accomplished with two uterine arteries (UA) with/without the anterior division of the internal iliac artery (IIA) in 36 cases (56.25%), with two UA with a segment or patch of the IIA in 24 cases (37.5%), and two UA…”

“…Fig.2Schematic diagram of the IIA representing the different levels of transection for arterial inflow. A segment of the IIA (blue scissor); a patch of the IIA (white semicircular double line); the anterior division of the IAA (yellow scissor) and uterine artery (purple scissor) 28,79. A, artery; IIA, internal iliac artery.…”