Emergency embolization of uterine artery pseudoaneurysm after cesarean section

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Abstract

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).

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About the authors

Sergey A. 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

Author for correspondence.
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

Russian Federation, Moscow; Moscow

Vasiliy V. 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)

Russian Federation, Moscow

Mikhail I. 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)

Russian Federation, Moscow

References

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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

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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)

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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

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