2016
DOI: 10.1111/jog.13140
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Novel approach to uterine artery pseudoaneurysm embolization for delayed post‐partum hemorrhage

Abstract: Uterine artery pseudoaneurysms (UAP) are a rare cause of post-partum hemorrhage. Conservative management is discouraged due to the risk of spontaneous hemorrhage. Intra-arterial embolization is highly successful (>90%) and offers definitive treatment. We present the case of a 27-year-old woman with significant delayed post-partum hemorrhage after cesarean section who was found to have a UAP on imaging. Her tortuous vascular anatomy and spasmodic aneurysmal neck presented technical challenges to embolization wi… Show more

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Cited by 4 publications
(5 citation statements)
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“…In general, on grayscale ultrasonography, pseudoaneurysm has a characteristic sonographic appearance consisting of a pulsating anechoic or hypoechoic well defined cystic structure with or without associated pelvic hematoma or free fluid [ 6 ]. On color Doppler, the pseudoaneurysm systolic and diastolic flow creates a characteristic “to-and-fro” pattern, classically described as the “Yin-Yang” sign [ 7 ]; it is caused by changes of the pressure in the pseudoaneurysm and the blood vessel during the cardiac cycle. However, in practice, it is difficult to show the neck because the uterine artery is very small.…”
Section: Discussionmentioning
confidence: 99%
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“…In general, on grayscale ultrasonography, pseudoaneurysm has a characteristic sonographic appearance consisting of a pulsating anechoic or hypoechoic well defined cystic structure with or without associated pelvic hematoma or free fluid [ 6 ]. On color Doppler, the pseudoaneurysm systolic and diastolic flow creates a characteristic “to-and-fro” pattern, classically described as the “Yin-Yang” sign [ 7 ]; it is caused by changes of the pressure in the pseudoaneurysm and the blood vessel during the cardiac cycle. However, in practice, it is difficult to show the neck because the uterine artery is very small.…”
Section: Discussionmentioning
confidence: 99%
“…The treatment of UAP includes expectant management [ 10 , 11 ], selective UAE, ligation of the internal iliac artery or uterine artery and its branches [ 12 ], intra-arterial catheter-directed thrombin injection [ 7 ], or percutaneous or transvaginal UGTI [ 13 ]; selective UAE is the first-line treatment. UAE is a safe treatment method with a high success rate and few reports of complications [ 14 ].…”
Section: Discussionmentioning
confidence: 99%
“…Most uterine artery pseudoaneurysms are successfully treated with gel foam and/or metallic coils 2 . A case report in the literature describes intra‐arterial thrombin administration 5 . Eriksson et al followed up patients after interventional treatment of uterine artery pseudoaneurysm and observed no case of infertility after embolization 6 .…”
Section: Discussionmentioning
confidence: 99%
“…We described our failed first attempts to access the pseudoaneurysm for coil embolization due to a tortuous and spasmotic uterine artery. 1 Although not specifically described in our article, the "various microcatheters" that failed did include the 2.4-Fr Progreat (Terumo, Tokyo, Japan). 1 While we respect the authors' rationale for considering gelatin sponge (Gelfoam: Pfizer, NY, USA) prior to other agents, we maintain our position for attempting thrombin for the following reasons.…”
mentioning
confidence: 98%