New prospects for high-intensity focused ultrasound ablation in the treatment of uterine arteriovenous fistula associated with retained products of conception: A retrospective cohort study

Uterine arteriovenous fistula (UAVF), characterized by abnormal connections between uterine arteries and veins, can cause life-threatening hemorrhage and poses significant challenges for fertility preservation in reproductive-age women. Conventional treatments, including hysteroscopy and uterine artery embolization, remain suboptimal due to risks of intraoperative bleeding, uterine ischemia, and postoperative adhesions. This study evaluated the efficacy and reproductive outcomes of high-intensity focused ultrasound (HIFU) as a noninvasive alternative. A retrospective cohort of 49 reproductive-age UAVF patients was divided into 3 groups: hysteroscopy alone (n = 26), uterine artery embolization combined with hysteroscopy (n = 11), and HIFU monotherapy (n = 12). Primary endpoints included treatment success rate, intraoperative blood loss, hospitalization duration, and fertility-related complications over a 6-month follow-up. HIFU group demonstrated superior clinical outcomes, with significantly shorter hospitalization, and reduced intraoperative blood loss. At 6-month follow-up, HIFU-treated patients exhibited lower rates of abnormal uterine bleeding and intrauterine adhesions. These findings establish HIFU as a promising noninvasive modality for UAVF management, offering dual advantages of effective hemorrhage control and enhanced fertility preservation. HIFU provides a more effective and safer therapeutic option for female patients with UAVF who have reproductive demands.