Post-operative hemorrhage after myomectomy: safety and efficacy of transcatheter uterine artery embolization

Abstract

Objective: To evaluate the safety and clinical efficacy of transcatheter uterine artery embolization (UAE) for post-myomectomy hemorrhage.

Materials and methods: We identified eight female patients (age ranged from 29 to 51 years and with a median age of 37) in two regional hospitals who suffered from post-myomectomy hemorrhage requiring UAE during the time period from 2004 to 2012. A retrospective review of the patients' clinical data, uterine artery angiographic findings, embolization details, and clinical outcomes was conducted.

Results: The pelvic angiography findings were as follows: hypervascular staining without bleeding focus (n = 5); active contrast extravasation from the uterine artery (n = 2); and pseudoaneurysm in the uterus (n = 1). Gelatin sponge particle was used in bilateral uterine arteries of all eight patients, acting as an empirical or therapeutic embolization agent for the various angiographic findings. N-butyl-2-cyanoacrylate was administered to the target bleeding uterine arteries in the two patients with active contrast extravasation. Technical and clinical success were achieved in all patients (100%) with bleeding cessation and no further related surgical intervention or embolization procedure was required for hemorrhage control. Uterine artery dissection occurred in one patient as a minor complication. Normal menstrual cycles were restored in all patients.

Conclusion: Uterine artery embolization is a safe, minimally invasive, and effective management option for controlling post-myomectomy hemorrhage without the need for hysterectomy.

Keywords: Digital subtraction angiography; Uterine artery embolization; Uterine myoma; Uterine myomectomy.

Fig. 1

34-year-old female patient (No. 7) presented with hemodynamic instability. A. Contrast-enhanced CT scan shows active contrast extravasation within uterine cavity (arrows) and peritoneal space (arrowheads) secondary to uterine rupture after myomectomy. B. Pelvic angiography (anterior-posterior view) confirms presence of active contrast extravasation (arrows). C. Subsequent angiogram (right anterior oblique view) obtained after selective cannulation of left uterine artery shows evidence of active contrast extravasation (arrow). D. Completion pelvic angiography demonstrates cessation of contrast extravasation after successful embolization with N-butyl-2-cyanoacrylate.

Fig. 2

51-year-old female patient (No. 2) presented with persistent intermittent vaginal bleeding. A. Contrast-enhanced CT scan six days before uterine artery embolization shows contrast extravasation (arrows) in myomectomy site. B. Selective right uterine arteriogram shows hypervascular staining (arrows) without definite active bleeding focus. Note tortuous right uterine artery (arrowhead). C. Left internal iliac arteriogram shows only tortuous left uterine artery (arrowheads) without bleeding focus. Both uterine arteries were embolized with gelatin sponge particles (not shown).