Extravascular Dispersion of Polyvinyl Alcohol Microsphere Particles in Uterine Artery Embolization

Clinical efficacy analysis of laparoscopic uterine artery pre-ligation combined with hysteroscopic curettage in the treatment of type II cesarean scar pregnancy

Objective

To explore and evaluate the clinical therapeutic effect of laparoscopic uterine artery pre-ligation combined with hysteroscopic curettage in the treatment of type II cesarean scar pregnancy.

Methods

This study analyzed the clinical data of patients with cesarean scar pregnancy (CSP) in the Maternal and Child Health Hospital of Hubei Province from 2018 to 2022. A total of 134 patients with type II cesarean section were enrolled, out of which 78 patients were included in the final analysis. Treatment included either uterine artery embolization (UAE) combined with hysteroscopic curettage (n = 37 patients) or laparoscopic uterine artery pre-ligation (LUAP) combined with hysteroscopic curettage (n = 41 patients). The demographic and clinical characteristics of these two groups were recorded, and their short- and long-term complications on follow-up were compared. For patients with subsequent fertility requirements, we followed up these patients for 2 years after surgery, then collected and analyzed the compared subsequent pregnancy outcome.

Results

We found no significant discrepancies in the success rate of operation, length of hospital stay, and intraoperative blood loss between the two different operation modes. The cost of LUAP was significantly lower than that of UAE. Furthermore, the incidence of short-term postoperative complications such as fever and pelvic pain was lower in patients treated with LUAP than in those treated with UAE. In terms of long-term postoperative complications, the recovery time for menstruation in the LUAP group (49.81 ± 11.47) was earlier than that in the UAE group (34.90 ± 7.41) (p < 0.05). Additionally, 4.9% of patients in the LUAP group had decreased menstrual flow, while 59% of patients in the UAE group had a marked decrease in menstrual flow, and the incidence and severity of intrauterine adhesions were significantly lower in the LUAP group than in the UAE group(p < 0.05). Consistent with the aforementioned observations, patients treated with LUAP had better postoperative re-pregnancy outcomes than those treated with UAE.

Conclusions

Based on the findings, LUAP combined with hysteroscopic curettage is a safe and effective surgical scheme for the treatment of type II CSPs. In addition, compared with UAE, LUAP is associated with a lower surgical cost, fewer short and long-term complications, and better postoperative pregnancy outcomes. Thus, it should be widely applied in patients with type II CSPs.

Peritoneal seeding of embolic beads after uterine artery embolization

Background

Incidental identification of peritoneal nodules during laparoscopy may present a diagnostic dilemma. The differential diagnosis includes a variety of benign and malignant entities such as peritoneal carcinomatosis.

Case

A 44-year-old G2P2 woman presented with recurrent menorrhagia and pelvic pain was found to have large uterine fibroids on imaging studies. Bilateral uterine artery embolization was performed with complete devascularization of the fibroid. Seven years later, she presented with similar symptoms. Imaging studies demonstrated a vascular uterine lesion. A total laparoscopic hysterectomy with bilateral salpingectomy was performed with no complications. During surgery, vesicular peritoneal implants were incidentally identified posterior to the uterus between the uterosacral ligaments. Biopsy and pathologic analysis of these nodules confirmed that they contained foreign material consistent with embolization beads. Pathologic analysis of the uterus demonstrated an intramural uterine fibroid, and presence of embolization beads in cervix, myometrium and bilateral peritubal regions.

Conclusion

Non-target peritoneal implantation of embolic beads after uterine artery embolization is a rare entity that can result in vesicular appearing nodules.