Endovascular treatment of cesarean scar pregnancy: a retrospective multicentric study

Failla, Giovanni; Libra, Federica; Giurazza, F.; Lucarelli, Nicola Maria; Coniglio, Giovanni; Vacirca, Francesco; Santonocito, Serafino Maria; Dell’Atti, Cristian; Camerano, Francesco; Palmucci, Stefano; Niola, Raffaella; Basile, Antonio; Patané, Domenico

doi:10.1007/s11547-022-01536-y

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…Roberts highlighted a 6.1% complication rate, demonstrating safety in bleeding ruptured VAPs [ 66 ]. Furthermore, the safety results of our report, including vascular access site complications, align with previous studies conducted on endovascular treatments and transcatheter arterial embolization [ 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 ]. Finally, this retrospective multicenter study provides further evidence supporting the safety and efficacy of endovascular embolization using EVOH copolymer-based non-adhesive liquid embolic agents (NALEAs) for the management of visceral pseudoaneurysms.…”

Section: Discussionsupporting

confidence: 88%

Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs)

Minici,

Guerriero,

Fontana

et al. 2023

Medicina

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Background and Objectives: Treatment of visceral artery pseudoaneurysms (VAPs) is always indicated regardless of their diameters, as their risk of rupture is significantly higher than that of visceral artery aneurysms. The invasiveness of surgery and its associated complications have led to a shift in favor of radiological interventions as the initial treatment of choice. However, there are still some unanswered questions on endovascular treatment of VAPs regarding the optimal endovascular technique and the efficacy and safety outcomes. The purpose of this multicenter study was to retrospectively evaluate the effectiveness and safety of endovascular treatment of visceral pseudoaneurysms using Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs). Materials and Methods: Consecutive patients who underwent endovascular embolization with EVOH-based NALEAs for visceral artery pseudoaneurysms between January 2018 and June 2023 were retrospectively evaluated. Results: 38 embolizations were performed. Technical success was achieved in all patients. The clinical success rate was high (92.1% overall), with no significant differences between ruptured and unruptured VAPs (p = 0.679). Seven patients (18.4%) experienced procedure-related complications, related to one case of non-target embolization, four splenic abscesses due to end-organ infarction, and two femoral pseudoaneurysms. The rates of procedure-related complications, end-organ infarction, and vascular access-site complications did not significantly differ between ruptured and unruptured VAPs (p > 0.05). Conclusions: Both ruptured and unruptured visceral pseudoaneurysms can be effectively and safely treated with NALEA-based endovascular embolization. We suggest considering the use of NALEAs, particularly in specific clinical cases that highlight their advantages, including patients with coagulopathy, fragile vessels, and embolization targets that are located at a considerable distance from the microcatheter tip and are otherwise difficult to reach.

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Section: Discussionsupporting

confidence: 88%

Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs)

Minici,

Guerriero,

Fontana

et al. 2023

Medicina

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“…As a treatment option for CSP, endovascular surgery, and uterine artery embolization are also proven to be effective. 45 , 46 The patient presented to our facility with mild symptoms, and an ultrasound examination identified heterotopic CSP with one viable intrauterine embryo aged 7 weeks and 5 days. A detailed explanation of HCSP's potential hazards and complexities, as well as management strategies, was given to the couple.…”

Section: Discussionmentioning

confidence: 99%

A rare case report of heterotopic cesarean scar pregnancy in the 8th week of gestation that was managed successfully by exploratory laparotomy with dilation and curettage

Karbasi,

Aletaha,

Ahangar‐Sirous

et al. 2024

Clinical Case Reports

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Key Clinical MessageSwift and precise identification of heterotopic cesarean scar pregnancy, coupled with standardized treatment approaches for handling possible serious complications, form an essential component in reaching favorable outcomes for patients experiencing this rare type of pregnancy.AbstractHeterotopic pregnancy (HP) denotes a form of multiple gestation where intrauterine and ectopic pregnancies coexist. Cesarean scar ectopic pregnancy, on the other hand, involves the implantation of a fetus over the previous cesarean scar. This condition poses a significant risk of uterine rupture, which may lead to serious health complications, and even death. We report a case of a fit 37‐year‐old woman with two previous cesarean deliveries who was diagnosed with a heterotopic cesarean scar pregnancy at 8 weeks gestation following symptoms of lower abdominal pain and delayed menstruation. Both pregnancies demonstrated cardiac activity and the portion of the myometrium located between the bladder wall and the gestational sac was noted to exhibit considerable thinness. The patient underwent an exploratory laparotomy coupled with dilation and curettage and recovered uneventfully. The proper management of a HCSP requires timely diagnosis through ultrasonography. Early diagnosis allows for immediate intervention to prevent complications such as uterine rupture or potentially lethal bleeding.

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“…Consequently, inadequate counselling may cause more harm than the radiation exposure itself [27][28][29]. The conditions surrounding inadvertent radiation exposure of a pregnant woman or any patient due to inaccurate counselling on the radiation risk may have medicolegal implications [12,15,23,26,30].…”

Section: Communicating Benefits and Risksmentioning

confidence: 99%

“…In any case, when a healthcare professional has to perform a diagnostic investigation, it is crucial that he keep in mind the fundamental principles of radiation protection, and this fact is even more important for a pregnant woman. Among these principles, the one that should be well known is the principle of optimization that the International Commission on Radiological Protection has named the "as low as reasonably achievable" (ALARA) principle, which states that, to obtain a diagnosis, the lowest possible dose level should be employed [10,13,[24][25][26][27][28][29][30][31]. In addition, "the principle of justification" should be considered, i.e., the appropriateness of the imaging allows you to perform only necessary radiological procedures, avoiding unjustified exposure [10,13].…”

Section: Imaging Toolsmentioning

confidence: 99%

“…In this regard, the mother should be clearly informed of the possibility of this event, and it should be part of the informed consent [6]. A radiation level lower than 50 mGy is not correlated to fetal injury or abortion [8]; so, considering that dose reduction and optimization are the main goals in the radiological field, in accordance with the "as low as reasonably achievable" (ALARA) principle, the fetus should not be exposed to doses approaching this threshold in most of the imaging examinations used in clinical practice [9][10][11][12]26].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dose Reduction Strategies for Pregnant Women in Emergency Settings

Picone

Fusco

Tonerini

et al. 2023

JCM

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In modern clinical practice, there is an increasing dependence on imaging techniques in several settings, and especially during emergencies. Consequently, there has been an increase in the frequency of imaging examinations and thus also an increased risk of radiation exposure. In this context, a critical phase is a woman’s pregnancy management that requires a proper diagnostic assessment to reduce radiation risk to the fetus and mother. The risk is greatest during the first phases of pregnancy at the time of organogenesis. Therefore, the principles of radiation protection should guide the multidisciplinary team. Although diagnostic tools that do not employ ionizing radiation, such as ultrasound (US) and magnetic resonance imaging (MRI) should be preferred, in several settings as polytrauma, computed tomography (CT) nonetheless remains the examination to perform, beyond the fetus risk. In addition, protocol optimization, using dose-limiting protocols and avoiding multiple acquisitions, is a critical point that makes it possible to reduce risks. The purpose of this review is to provide a critical evaluation of emergency conditions, e.g., abdominal pain and trauma, considering the different diagnostic tools that should be used as study protocols in order to control the dose to the pregnant woman and fetus.

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Endovascular treatment of cesarean scar pregnancy: a retrospective multicentric study

Cited by 8 publications

References 27 publications

Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs)

Endovascular Treatment of Visceral Artery Pseudoaneurysms with Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs)

A rare case report of heterotopic cesarean scar pregnancy in the 8th week of gestation that was managed successfully by exploratory laparotomy with dilation and curettage

Dose Reduction Strategies for Pregnant Women in Emergency Settings

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