PITFALLS TO AVOID WHILE EMBOLIZING PSEUDOANEURYSMS OF THE UTERINE ARTERY- A CASE SERIES.

Abstract

AIM:

To emphasize the need for bilateral uterine artery embolization in cases of unilateral pseudoaneurysms, due to the rich collateral blood supply of the uterus.

BACKGROUND:

Postpartum hemorrhage remains one of the major causes of maternal mortality. Secondary postpartum hemorrhage is defined as excessive bleeding starting any time from 24 hours after delivery up to 6 weeks postpartum. Uterine artery pseudoaneurysm is a rare cause of secondary postpartum hemorrhage.

PROCEDURAL DETAILS:

Two similar cases are discussed. Both patients presented with PV bleeding following c-section in which routine gynecological interventions had failed to identify the cause of bleeding and neither could the bleeding be controlled. Hysterectomy had been declined by both women and they were referred to our institution, being the regional IR center.

Cross sectional imaging reliably diagnosed pseudoaneurysms in both cases and initial unilateral uterine artery embolization was performed with PVA particles ranging in size from 355 to 500 microns. In both cases despite technical success the bleeding did not abate and catheter angiography repetition needed. Interestingly in both cases reperfusion of the pseudoaneurysms was seen from the contralateral side, which was not apparent on the final angiograms performed at the end of the initial embolization.

Following repeat embolization of the contralateral uterine artery, hemostasis was achieved and both recovered uneventfully with no further intervention or adverse sequlae.

CONCLUSION:

The uterus has a rich blood supply with good collateral flow and cross filling, especially in the post partum period. Embolization of the target vessel on one side is often not sufficient and both uterine arteries must be embolized in the same setting to prevent re-bleeding.