High-intensity focused ultrasound combined with hysteroscopic surgery for placenta accreta with uterine arteriovenous fistula: A case report

Uterine arteriovenous fistula (UAVF)To the Editor, A 33-year-old G4P3 woman underwent medical termination for a 17-week missed miscarriage.Seventeen days later, Doppler ultrasound revealed a 24 × 18 mm right upper uterine lesion with ill-defined margins and mosaic vascularity, RI 0.37 (Fig. 1A).Pelvic MRI demonstrated a 26 × 25 × 26 mm ill-defined nodule near the right uterine cornu, tortuous linear hypointense, and a separate 19 mm lesion with indistinct junctional zone margins (Fig. 1 B).Findings suggested invasive retained placenta with suspected UAVF.After counseling, consent was obtained for sequential HIFU ablation followed by hysteroscopic resection.HIFU delivered 321,600 J over 804 s at 400 W. Target tissue whitened at 50 s;