Successful term pregnancy after selective embolization of a large postmolar uterine arteriovenous malformation

Transarterial embolization for management of severe postcoital bleeding

Objectives:

Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management.

Methods:

We report a case of severe postcoital bleeding in a young woman requiring blood transfusion.

Results:

Hemostasis was achieved using subselective embolization of cervical artery by metallic coils.

Conclusion:

Our case demonstrates a minimally invasive treatment for control of non-obstetric hemorrhage.

Successful treatment of acquired uterine arterial venous malformation using N-butyl-2-cyanoacrylate under balloon occlusion

We present two cases of acquired uterine arterial venous malformation (AVM) which was diagnosed because of massive genital bleeding successfully treated with transcatheter arterial embolization (TAE), using N-butyl-2-cyanoacrylate (NBCA) under balloon occlusion. Balloon occlusion at the uterine artery was performed in both patients for diffuse distribution of NBCA in multiple feeding branches, as well as to the pseudoaneurysm, and for the prevention of NBCA reflux. In one of our patients, balloon occlusion of the draining vein was simultaneously performed to prevent NBCA migration through accompanying high-flow arteriovenous fistula (AVF). Doppler ultrasound at 6 months of both patients documented persistent complete occlusion of AVM. Complete and safe obliteration of acquired uterine AVM was accomplished using NBCA as embolic agent, under balloon occlusion at the communicating vessels of acquired uterine AVM.

A case of pregnancy and childbirth after uterine artery embolization with a permanent embolic agent

OBJECTIVE

To report a case of full-term delivery after uterine artery embolization with N-butyl cyanoacrylate for abruptio placentae.

DESIGN

Case report.

SETTING

University hospital.

PATIENT(S)

A 35-year old woman, gravida 2 para 0, at 32 weeks' and 4 days' gestation.

INTERVENTION(S)

Transcatheter arterial embolization with N-butyl cyanoacrylate (NBCA).

RESULT(S)

An emergency cesarean section was performed for abruptio placentae. The neonate died on day 0. After the cesarean section, a hematoma was found at the uterine incision that continued to increase. Therefore, pelvic angiography was performed, and extravasation was observed from the uterine arteries. NBCA was used for embolization, and the extravasation stopped rapidly. Total transfusion volume was 10,190 mL. Nine months after the cesarean section, the patient became pregnant naturally and delivered a boy by elective cesarean section.

CONCLUSION(S)

For treatment of shock caused by perinatal hemorrhage, which is a major cause of perinatal mortality, even if clotting abnormalities are present, transcatheter arterial embolization using NBCA can provide effective hemostasis. Moreover, in patients who would otherwise require a hysterectomy, fertility can be preserved.

Contemporary diagnosis and management of a uterine arteriovenous malformation

BACKGROUND

Uterine arteriovenous malformations (AVMs) are extremely rare and can result in severe complications. Experience with diagnosis and management of these vascular malformations is very limited.

CASE

We report on a patient with a history of nonmetastatic gestational trophoblastic disease. The patient developed a concomitant 4.4-cm intrauterine mass, suggestive of a molar pregnancy, during her second pregnancy. Despite suction and sharp curettage, the mass and menorrhagia persisted. After complex diagnostic imaging, the diagnosis of a uterine AVM was made. Subsequently, the patient underwent uterine arterial embolization and laparoscopic surgery to resect the mass.

CONCLUSION

Because uterine AVMs are infrequently encountered, they initially may not be included in the differential diagnosis. The use of contemporary imaging, interventional radiology, and surgery can optimize patient outcome.