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Jannusch K, Steuwe A, Schimmöller L, Dietzel F, Wilms LM, Weiss D, Ziayee F, Fehm TN, Schlimgen C, Poth V, Ziegler RT, Minko P. Endovascular coil-embolization of an unruptured, true UAA during early pregnancy- a case report. CVIR Endovasc 2023; 6:50. [PMID: 37870638 PMCID: PMC10593720 DOI: 10.1186/s42155-023-00398-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND True uterine artery aneurysms, especially during pregnancy, are a rare entity and not well understood. Clinical symptoms are unspecific pelvic pain and pressure. Diagnosis can be confirmed by transvaginal color-coded-sonography and/or magnetic resonance imaging. Because of potential risk of rupture, immediate interdisciplinary discussion and treatment planning in the best interests of both mother and child is crucial. CASE PRESENTATION We present a 31-year-old pregnant woman with increasing pelvic pain and pressure. Diagnosis of an unruptured uterine artery aneurysm was confirmed by color-coded-sonography and magnetic resonance angiography. After interdisciplinary consultation, successful endovascular super-selective coil-embolization was performed by using X-ray fluoroscopy. Thus, fetal radiation dose during treatment with 4.33 mGy (VirtualDoseTM) was as low as possible with no immediate harm to the fetus. CONCLUSIONS Unruptured true uterine artery aneurysms can be successfully treated by endovascular super-selective coil-embolization during early pregnancy with no immediate harm to the fetus.
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Affiliation(s)
- Kai Jannusch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany.
| | - Andrea Steuwe
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Lars Schimmöller
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Frederic Dietzel
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Lena M Wilms
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Daniel Weiss
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Farid Ziayee
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
| | - Tanja Natascha Fehm
- Medical Faculty, Department of Gynecology, University Dusseldorf, Dusseldorf, D-40225, Germany
| | - Charlotte Schlimgen
- Medical Faculty, Department of Gynecology, University Dusseldorf, Dusseldorf, D-40225, Germany
| | - Vanessa Poth
- Department of Gynecology, Hermann-Josef Hospital, Erkelenz, D-41812, Germany
| | - Reinhold Thomas Ziegler
- Medical Faculty, Department of Vascular and Endovascular Surgery, University Dusseldorf, Dusseldorf, D-40225, Germany
| | - Peter Minko
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, Dusseldorf, D-40225, Germany
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An Unruptured True Aneurysm of the Uterine Artery during Pregnancy. Diagnostics (Basel) 2022; 12:diagnostics12102459. [PMID: 36292147 PMCID: PMC9600217 DOI: 10.3390/diagnostics12102459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
The antenatal diagnosis of an unruptured true aneurysm of the uterine artery is extremely rare and has never been reported, whereas pseudoaneurysms associated with previous trauma or cesarean section have been reported several times. True aneurysms occur when the artery or vessel weakens and bulges, sometimes forming a blood-filled sac. Nearly all cases of pelvic true aneurysms involved ovarian arteries which ruptured during the peripartum period. The case presented here is unique in terms of being an unruptured true aneurysm of the uterine artery with a first diagnosis during pregnancy at 32 weeks of gestation and the spontaneous development of thrombosis in the aneurysm in late pregnancy, documented at 37 weeks of gestation. The diagnosis of a true aneurysm of the uterine artery was based on, (1) a demonstration of the cystic mass located in proximity to the lower segment of the uterus with ultrasound characteristics of arterial flow in the mass, and (2) the occurrence in a woman who had no history of trauma or surgery in the pelvis. The finding during cesarean section confirmed the prenatal sonographic finding. The pregnancy ended with successful outcomes.
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Habek D, Pavlović G. Juxtaisthmic uterine rupture caused by arterial aneurysm. Z Geburtshilfe Neonatol 2022; 226:71. [PMID: 35008111 DOI: 10.1055/a-1634-1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Dubravko Habek
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh", Zagreb, School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| | - Goran Pavlović
- Department of Gynecology and Obstetrics, General Hospital, Bjelovar, Croatia
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True Aneurysm of Ovarian and Uterine Arteries:a Comprehensive Review. Ann Vasc Surg 2020; 72:610-616. [PMID: 33227474 DOI: 10.1016/j.avsg.2020.09.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gonadal artery aneurysm represents an extremely rare condition often unrecognized until rupture. METHODS A literature review was undertaken on Pubmed from 1990 to 2020 to identify reported cases of ovarian and uterine artery aneurysms, including the index case presented here. Data about the clinical presentation, diagnostic approach, and treatment were collected. RESULTS Twenty-one articles reporting on data about 22 patients, including the index case, were included. The patients's median age was 46.7 years (range 30-80) and aneurysm maximal diameter 2.6 cm (range 0.75-5 cm). Except for one asymptomatic patient, the aneurysm's clinical presentation was abdominal/back pain in the majority of cases (n = 20, 90.9%). Rupture with retroperitoneal hematoma occurred in 16 cases (72.7%) and hemorrhagic shock in one case (4.5%). No history of vaginal bleeding was reported in any case. The majority of the aneurysms were diagnosed in women of childbearing age: in 50% (n = 11) of cases during the peripartum period and in 22.7% (n = 5) of cases during the postmenstruation period. The remaining cases (n = 6, 27.3%) were detected during the postmenopausal period. The majority of patients (n = 15, 68.2%) were emergently treated with an endovascular approach by embolization, achieving the total exclusion of the aneurysm in 86.7% of cases (13 patients). In 7 cases (31.8%), surgical ligation was performed, of which 2 (9.1%) were for the failure of a primarily attempted coils embolization. The spontaneous thrombosis of the uterine aneurysm was noted 3 months after the initial diagnosis in one patient. CONCLUSIONS The Gonadal artery aneurysms are unrecognized entities until an acute rupture occurs. Endovascular treatment by embolization is progressively becoming the first-line treatment with satisfactory results.
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