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J Korean Soc Radiol. 2019 Jan;80(1):98-104. English. Original Article. https://doi.org/10.3348/jksr.2019.80.1.98
Lee JM , Park JS , Shim JJ .
Department of Radiology, Soonchunhyang University Hospital, Bucheon, Korea. jspark@schmc.ac.kr
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.

Copyright © 2019. Korean Association of Medical Journal Editors.