Emergency embolization of uterine artery pseudoaneurysm after cesarean section

Capa

Citar

Texto integral

Acesso aberto Acesso aberto
Acesso é fechado Acesso está concedido
Acesso é fechado Acesso é pago ou somente para assinantes

Resumo

Relevance: Uterine artery pseudoaneurysm is a rare and potentially life-threatening pathology of the arterial system. It can occur due to the damage to tissues during complicated vaginal delivery or cesarean section, uterine surgery, adnexal surgery (myomectomy, hysterectomy, metroplasty, cervicoplasty, perforation of the uterus during curettage or during diagnostic manipulations, removal of various tumors in the pelvic area, and others). This may be a rare cause of delayed postpartum hemorrhage in 3–6 cases per 1000 births.

Case report: A 25-year-old primigravida underwent an emergency cesarean section in the lower uterine segment due to an acute intrauterine fetal hypoxia at 40–41 weeks gestation. On the 4th day after surgery, she complained of an increase in body temperature to 37.5°C, nagging pains in the left iliac region. Doppler ultrasound imaging of the pelvic area to the left of the uterus revealed a pathological vascular formation in the parametrium. An emergency angiography of the pelvic vessels was performed, it was followed by embolization with two coils of the branches of the uterine artery feeding the pseudoaneurysm. Seven years after the operative delivery and embolization, the patient became pregnant and had a planned cesarean section at 40 weeks gestation without complications.

Conclusion: The first diagnostic method in an emergency situation is Doppler sonography. The method of choice in the treatment of uterine artery pseudoaneurysm is embolization of the feeding artery (provided there are conditions for such an operation).

Texto integral

Acesso é fechado

Sobre autores

Sergey Kondrashin

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University); Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Autor responsável pela correspondência
Email: kondrashin_s_a@staff.sechenov.ru
ORCID ID: 0000-0002-3492-9446

Dr. Med. Sci., Professor, Professor of the Department of Radiation Diagnostics and Radiation Therapy of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University); Leading Researcher at the Department of X-ray Diagnostic, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Rússia, Moscow; Moscow

Vasiliy Koblikov

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: kondrashin_s_a@staff.sechenov.ru
ORCID ID: 0000-0002-9661-8686

Dr. Med. Sci., Assistant at the Department of Radiation Diagnostics and Radiation Therapy of the N.V. Sklifosovsky Institute of Clinical Medicine, REDT doctor at the Department of X-ray surgical methods of diagnosis and treatment of University Clinical Hospital No. 1, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University)

Rússia, Moscow

Mikhail Kovalev

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: kondrashin_s_a@staff.sechenov.ru
ORCID ID: 0000-0002-0426-587X

Dr. Med. Sci., Professor, Professor of the Department of Obstetrics and Gynecology No. 1 of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University)

Rússia, Moscow

Bibliografia

  1. Wu C.Q., Nayeemuddin M., Rattray D. Uterine artery pseudoaneurysm with an anastomotic feeding vessel requiring repeat embolization. BMJ Case Rep. 2018; 2018: bcr2018224656. https://dx.doi.org/10.1136/bcr-2018-224656.
  2. Baba Y., Takahashi H., Ohkuchi A., Suzuki H., Kuwata T., Usui R. et al. Uterine artery pseudoaneurysm: its occurrence after non-traumatic events, and possibility of "without embolization" strategy. Eur. J. Obstet. Gynecol. Reprod. Biol. 2016; 205: 72-8. https://dx.doi.org/10.1016/j.ejogrb.2016.08.005.
  3. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet. Gynecol. 2017;130(4):e168-e186. https://dx.doi.org/10.1097/AOG.0000000000002351.
  4. Jennings L., Presley B., Krywko D. Uterine Artery Pseudoaneurysm: A life-threatening cause of vaginal bleeding in the Emergency Department. J. Emerg. Med. 2019; 56(3): 327-31. https://dx.doi.org/10.1016/j.jemermed.2018.12.016.
  5. Böckenhoff P., Kupczyk P., Lindner K., Strizek B., Gembruch U. Uterine artery pseudoaneurysm after an uncomplicated vaginal delivery: a case report. Clin. Pract. 2022; 12(5): 826-31. https://dx.doi.org/10.3390/clinpract12050087.
  6. Yeniel A.O., Ergenoglu A.M., Akdemir A., Eminov E., Akercan F., Karadadaş N. Massive secondary postpartum hemorrhage with uterine artery pseudoaneurysm after cesarean section. Case Rep. Obstet. Gynecol. 2013; 2013: 285846. https://dx.doi.org/10.1155/2013/285846.
  7. Pohlan J., Hinkson L., Wickmann U., Henrich W., Althoff C.E. Pseudo aneurysm of the uterine artery with arteriovenous fistula after cesarean section: A rare but sinister cause of delayed postpartum hemorrhage. J. Clin. Ultrasound. 2021;49(3):265-8. https://dx.doi.org/10.1002/jcu.22890.
  8. Brown B.J., Heaston D.K., Poulson A.M., Gabert H.A., Mineau D.E., Miller F.J.Jr. Uncontrollable postpartum bleeding: a new approach to hemostasis through angiographic arterial embolization. Obstet. Gynecol. 1979; 54(3): 361-5.
  9. Гаврилов С.Г., Масленников М.А., Москаленко Е.П., Кирсанов К.В., Юмин С.М., Гришин В.В. Случай успешного лечения ложной аневризмы левой маточной артерии с артериовенозной фистулой и варикозной трансформацией тазовых вен. Анналы хирургии. 2015; 6: 45-8. [Gavrilov S.G., Maslennikov M.A., Moskalenko E.P., Kirsanov K.V., Yumin S.M., Grishin V.V. Succesful treatment of false aneurysm of the left uterine artery with arteriovenous fistula and pelvic varicose transformation of veins. Annals of Surgery. 2015; 6: 45-8 (in Russian)].
  10. Wu T., Lin B., Li K., Ye J., Wu R. Diagnosis and treatment of uterine artery pseudoaneurysm: case series and literature review. Medicine. 2021;100(51): e28093. https://dx.doi.org/10.1097/MD.0000000000028093.
  11. Chainarong N., Deevongkij K., Petpichetchian C. Secondary postpartum hemorrhage: Incidence, etiologies, and clinical courses in the setting of a high cesarean delivery rate. PLoS One. 2022; 17(3): e0264583. https://dx.doi.org/10.1371/journal.pone.0264583.
  12. Kim B.M., Jeon G.S., Choi M.J., Hong N.S. Usefulness of transcatheter arterial embolization for eighty-three patients with secondary postpartum hemorrhage: Focusing on difference in angiographic findings. World J. Clin. Cases. 2023; 11(15): 3471-80. https://dx.doi.org/10.12998/wjcc.v11.i15.3471.
  13. Квашин А.И., Мельник А.В., Шарифулин М.А. Эндоваскулярная коррекция псевдоаневризмы правой маточной артерии. Клинический случай Международный журнал интервенционной кардиоангиологии. 2010; 22: 42-4. [Kvashin A.I., Melnik A.V., Sharifulin M.A. Endovascular correction of pseudoaneurysm of the right uterine artery. Clinical Case. International Journal of Interventional Cardioangiology. 2010; 22: 42-4 (in Russian)].
  14. Gupta A., Durairaj J., Nayak D. Successful pregnancies after embolization for uterine artery pseudoaneurysm: a report of two cases. J. Obstet. Gynaecol. India. 2021; 71(1): 88-90. https://dx.doi.org/10.1007/s13224-020-01365-x.

Arquivos suplementares

Arquivos suplementares
Ação
1. JATS XML
Baixar
2. Fig. 1. Selective arteriography of the left internal iliac artery. In the left half of the pelvis, a rounded formation approximately 4.0x3.5 cm (*) is determined, filled with contrast from two feeding arteries (arrows) extending from the anterior trunk of the internal iliac artery

Baixar (995KB)
Metadados
3. Fig. 2. Embolization of the feeding artery. A – superselective arteriography of the superior feeding artery. A catheter (arrow) is installed in the superior feeding artery, from which the pseudoaneurysm is filled with contrast. Below, the urinary bladder (UB) and the spiral in the inferior feeding artery are visible (dashed arrow). B – control arteriography of the superior feeding artery. The coil (arrow) is installed in the superior feeding artery; the filling of the pseudoaneurysm (*) is not determined. The spiral in the lower feeding artery is also visible (dashed arrow)

Baixar (1MB)
Metadados
4. Fig. 3. Emmobilization of pseudoaneurysm of the left uterine artery. On the left is arteriography of the left common iliac artery. In the left half of the small pelvis, a rounded formation approximately 4.0x3.5 cm is detected, filled with contrast from the internal iliac artery system (*). On the right is control arteriography of the left common iliac artery. In the first half of the pelvis, the formation (*) is not contrasted

Baixar (2MB)
Metadados

Declaração de direitos autorais © Bionika Media, 2023

Este site utiliza cookies

Ao continuar usando nosso site, você concorda com o procedimento de cookies que mantêm o site funcionando normalmente.

Informação sobre cookies