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Case Reports
. 2018 Jul 11:2018:bcr2018224656.
doi: 10.1136/bcr-2018-224656.

Uterine artery pseudoaneurysm with an anastomotic feeding vessel requiring repeat embolisation

Clara Q Wu  1 , Mohammed Nayeemuddin  2 , Darrien Rattray  1
Affiliations
Case Reports

Uterine artery pseudoaneurysm with an anastomotic feeding vessel requiring repeat embolisation

Clara Q Wu et al. BMJ Case Rep. .

Abstract

Uterine artery pseudoaneurysm (UAP) is a rare cause of delayed postpartum haemorrhage. Early diagnosis and endovascular management are effective in treating this condition. We present the case of a 36-year-old gravida 3, para 2 woman with delayed postpartum haemorrhage and endometritis following a spontaneous vaginal delivery. Ultrasound and catheter angiogram demonstrated a UAP arising from the distal aspect of the left uterine artery. Significant bleed persisted despite selective bilateral uterine artery embolisation. A repeat angiogram confirmed complete occlusion of bilateral uterine arteries, but abdominal aortogram demonstrated that the left ovarian artery was now feeding the pseudoaneurysm. A repeat embolisation procedure was performed to occlude the left ovarian artery. The patient was discharged the following day. Selective arterial embolisation is effective in the management of UAP. Persistent bleeding despite embolisation should raise the suspicion of anastomotic vascular supply and may require repeat embolisation.

Keywords: interventional radiology; obstetrics, gynaecology and fertility; pregnancy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Transabdominal ultrasound with colour Doppler demonstrates an anechoic oval structure projecting into the uterine endometrial cavity. (B) Colour Doppler mode reveal a ‘yin-yang sign’ in keeping with an arteriovenous malformation.
Figure 2
Figure 2
Pelvic angiogram demonstrates a pseudoaneurysm (see arrow) arising from the distal branches of the left uterine artery.
Figure 3
Figure 3
Post bilateral uterine artery embolisation with gelfoam of (A) right and (B) left uterine arteries.
Figure 4
Figure 4
Circumscribed homogenously enhancing intraluminal mass connected with a thin vascular pedicle to the spiral arteries consistent with a pseudoaneurysm that recanalised despite previous gelfoam embolisation. The arrow points to the pseudoaneurysm.
Figure 5
Figure 5
Persistent occlusion of previously (24 hours prior) gelfoam embolised right (A) and left (B) uterine arteries. The previously demonstrated pseudoaneurysm is no longer identified on the left (B) on selective bilateral internal iliac angiograms.
Figure 6
Figure 6
Pseudoaneurysm fed by the left ovarian artery arising from the left renal artery. Pseudoaneurysm successfully embolised using glue/lipiodol (1:3). (A) Origin of the ovarian artery arising from the left renal artery. (B) Left ovarian artery feeding the pseudoaneurysm via vascular anastomosis. (C) Complete occlusion of left ovarian artery and the pseudoaneurysm. The arrows in (A) and (B) demonstrate the vessels feeding the pseudoaneurysm, whereas the arrow in (C) shows the occluded pseudoaneurysm.
Figure 7
Figure 7
Left renal angiogram and abdominal aortogram demonstrate complete exclusion of the left uterine artery pseudoaneurysm.
See this image and copyright information in PMC

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