Transcatheter Embolization for the Treatment of Both Vaginal and Lower Intestinal Bleeding Due to Advanced Pelvic Malignancy

Abstract

We report a 31-year-old woman with end-stage cervical carcinoma who suff ers both lower intestinal and vaginal bleeding. A selective internal iliac arteriogram demonstrated pseudoaneurysm formation in the vaginal branch of the left internal iliac artery. There was also a fi stula between the pseudoaneurysm and the lower intestinal segments. Selective transcatheter coil embolization was performed, and the bleeding was treated successfully. We conclude that the internal iliac artery should be evaluated fi rst in patients with advanced pelvic malignancy when searching for the source of lower gastrointestinal (GI) bleeding. Additionally, transcatheter arterial embolization is a safe and eff ective treatment technique.Key Words: Angiography, Coil embolization, Hemorrhage, Lower gastrointestinal bleeding, Transcatheter ÖzetEş zamanlı vajinal ve alt intestinal kanamalı son dönem servikal kanseri bulunan 31 yaşındaki kadın hastanın transkateter koil embolizasyonunu sunuyoruz. Hastanın selektif iliak arteriogramında sol internal iliak arterinin vajinal dalında yalancı bir anevrizma formasyonu ve yalancı anevrizma ile alt intestinal segmentlerde fistül traktı gözlenmesi üzerine anjiografik girişim planlandı. Selektif koil embolizasyonu ile kanama başarılı olarak tedavi edildi.Olgudan çı-kardığımız sonuç ileri evre pelvik malignitesi olan hastalardaki alt intestinal kanamalarda öncelikle internal iliak arter çalışılmalıdır. Embolizasyon tedavileri de gelişen teknoloji ile birlikte oldukça başarılı hale gelmiştir.

Emergency Embolization of Pelvic Vessels in Patients With Locally Advanced Cervical Cancer and Massive Vaginal Bleeding: A Case Series in a Latin American Oncological Center

“…There are multiple studies that have shown the role of selective pelvic-vessels embolization in cervical cancer ( Table 3 ). 4 , 9 , 11 - 17 …”

“…Ligation of the hypogastric artery is one method to stop bleeding due to cervical cancer, with a reported 85% decrease in blood flow from the bleeding area. 4 However, due to the frequent recurrence of revascularization hemorrhage, it has been shown that hypogastric artery ligation alone is not enough and might require concomitant ligation of the infundibulopelvic, round, and uterosacral ligaments. On the other hand, in these patients, surgical management can add intraoperative or anesthetic complications to the patient’s already critical condition.…”

“…On the other hand, in these patients, surgical management can add intraoperative or anesthetic complications to the patient’s already critical condition. 4 …”

Uterine Arteriovenous Malformation: A Pictorial Review of Diagnosis and Management

“…Transcatheter arterial embolization has been shown in multiple studies to be highly successful in treating both vaginal and lower intestinal bleeding caused by UAVM. [71][72][73] The most commonly used embolic agent was polyvinyl alcohol particles. Other embolic agents included coils or (G, H) Contrast-enhanced dynamic magntic resonance angiography (MRA) images with coronal maximum intensity projection (MIP) show that the nidus of UAMV is fed by uterine arteries (red arrows), numerous vessels proliferate inside and around the lesion, and there is not early drainage via the system veins (ovarian and pelvic veins) in this phase.…”