J Korean Soc Radiol.  2019 Jan;80(1):98-104. 10.3348/jksr.2019.80.1.98.

The Effectiveness of Pelvic Arterial Embolization for Intractable Postpartum Hemorrhage after Hysterectomy

• Lee JM
• Park JS
• Shim JJ

• KMID: 2442468
• DOI: http://doi.org/10.3348/jksr.2019.80.1.98

Abstract

PURPOSE
To evaluate the effectiveness of pelvic arterial embolization (PAE) for intractable postpartum hemorrhage (PPH) after hysterectomy.
MATERIALS AND METHODS
From March 2011 to December 2017, 14 patients who received PAE for PPH that persisted after total abdominal hysterectomy were included (mean age, 33.6 years; range, 26-37 years). The delivery type, cause of PPH, and angiographic findings were investigated. The technical and clinical success rates and clinical outcomes were evaluated.
RESULTS
Of 14 patients, 8 patients (57%) had positive angiographic findings for bleeding; contrast extravasation (n = 6), and pseudoaneurysm (n = 2). Remnant uterine artery (UA) was the most common bleeding focus (n = 4), followed by vaginal artery (n = 2), left lateral sacral artery (n = 1), and left internal pudendal artery (n = 1). Technical and clinical success rates were 100% and 93% (13/14), respectively. In 1 patient, bleeding was not controlled after initial selective embolization and the entire anterior divisions of both internal iliac arteries were embolized with gelfoam.
CONCLUSION
PAE for persistent PPH after hysterectomy is a safe and effective treatment. Remnant UA was the most common bleeding site and all patients recovered without any significant sequelae after embolization.

MeSH Terms

Aneurysm, False
Arteries
Gelatin Sponge, Absorbable
Hemorrhage
Humans
Hysterectomy*
Iliac Artery
Postpartum Hemorrhage*
Postpartum Period*
Uterine Artery

Figure

• 

  Fig. 1. A 36-year-old female patient (no. 8) with active bleeding and hemodynamic instability. A. Contrast-enhanced CT performed at admission shows active contrast leakage (arrows) into the uterus and hematoma inside the uterus. B. The right iliac angiogram shows a remnant right UA and pseudoaneurysm at its distal portion (arrow). The remnant left UA is seen on the left side, but there is no active bleeding (not shown). C. After the embolization of the remnant right UA, the pseudoaneurysm on the angiogram disappears. PVA embolization was performed on the left UA. PVA = polyvinyl alcohol, UA = uterine artery

• 

  Fig. 2. A 26-year-old patient (no. 3) with persistent bleeding after coil embolization. A. The left IIA angiogram shows a small pseudoaneurysm (arrow) with contrast leakage in the lateral sacral artery. B. After coil embolization, the pseudoaneurysm has disappeared. C. On the next day, left iliac artery angiogram was done because of persistent vaginal bleeding. There is no active bleeding or visualized pseudoaneurysm on the angiogram. Gelfoam embolization was performed on the anterior division of the bilateral IIA. IIA = internal iliac artery

Reference

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