Modified sandwich embolization technique for postpartum hemorrhage caused by uterine artery pseudoaneurysm: a case serie
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GYNECOLOGIC ONCOLOGY
Modified sandwich embolization technique for postpartum hemorrhage caused by uterine artery pseudoaneurysm: a case series Mimi Zhou1 · Tingwei Chen1 · Yongsen Li1 · Qianyan Tan1 · Huawei Shen1 · Duzhou Zheng1 · Shikuan Huang1 · Mingjin Cai1 Received: 23 November 2019 / Accepted: 2 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Uterine artery pseudoaneurysm (UAP) is rare but can cause life-threatening postpartum hemorrhage (PPH). To evaluate a novel sandwich embolization technique as a treatment for PPH caused by UAP. Methods This retrospective study included 10 patients with PPH caused by UAP who were treated using a modified sandwich embolization technique at the Radiology Department, Third Affiliated Hospital of Guangzhou Medical University between April 2009 and September 2018. Baseline clinical characteristics, intraoperative data (including treatment effectiveness) and postoperative data (including re-bleeding events and complications) were extracted from the medical records. Results Uterine arterial angiography showed cystic shadowing of the vascular wall during the arterial phase in all patients. Spraying of contrast agent into the pseudoaneurysm was observed for large UAPs, and the pseudoaneurysm disappeared in the venous phase. The pseudoaneurysm blood supply was from the uterine artery in 9 patients (90%) and the uterine, superior vesical, internal pudendal and nameless little arteries in 1 patient (10%). Bleeding symptoms were completely relieved in all patients after sandwich embolization. Eight patients experienced painful contractions in the perioperative period, but there were no other postoperative complications. During the 1-year postoperative follow-up, 9 patients (90%) had no re-bleeding symptoms/signs. One patient (10%), who had a pseudoaneurysm supplied by the uterine, superior vesical, internal pudendal and nameless little arteries, experienced re-bleeding 20 days after surgery and was treated by hysterectomy. Conclusion Modified sandwich embolization is an effective treatment for PPH caused by UAP. Keywords Therapeutic embolization · Uterine artery embolization · Pseudoaneurysm · Postpartum hemorrhage
Introduction Postpartum hemorrhage (PPH) is defined as blood loss of ≥ 500 mL after vaginal delivery or ≥ 1000 mL after cesarean section [1]. Primary PPH occurs within 24 h after delivery while secondary (or late) PPH occurs more than 24 h after delivery [1]. Secondary PPH most commonly presents during the second week after delivery, and although it occurs in
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