Embolization of iatrogenic uterine pseudoaneurysm

Abstract

Uterine artery pseudoaneurysms (UAPs) are rare vascular lesions that may be life threatening if not diagnosed and properly treated. The clinical presentation of UAPs includes a spectrum of symptoms that are often associated with other and more frequent gynecologic/obstetric pathologies, both with and without vaginal bleeding, and may span from postpartum hemorrhage to the absence of symptoms. We report cases of two patients with UAP, both of whom were diagnosed with ultrasonography and contrast-enhanced computed tomography and successfully treated with transcatheter embolization. The first patient presented delayed hypovolemic shock following surgery for endometriosis, whereas the second patient suffered from postpartum hemorrhage after cesarean section. Diagnosis of UAPs relies on noninvasive imaging; transcatheter arterial embolization is an effective treatment to control bleeding in both hemodynamically stable and unstable patients.

Keywords: postoperative pelvic hemorrhage; postpartum hemorrhage; uterine artery embolization; uterine pseudoaneurysm.

Figure 1

A 34-year old woman with hemorrhagic shock after pelvic surgery for endometriosis. (A) Contrast-enhanced computed tomography shows a pseudoaneurysm close to the left aspect of the uterus (arrow: enlarged left uterine artery; asterisk: circular stapling of sigmoid resection). (B) Digital subtraction angiography of the left internal iliac artery (left anterior oblique view, late phase) confirms the diagnosis of extrauterine pseudoaneurysm supplied by the left uterine artery. (C) Native X-ray direct image of the pelvis after manual superselective arteriography: intraperitoneal diffusion of the contrast medium without evidence of the pseudoaneurysm. (D) Postembolization digital subtraction angiography artery shows the persistent occlusion of the pseudoaneurysm.

Figure 2

A 21-year old woman with postpartum hemorrhage. (A) Digital subtraction angiography of the left internal iliac artery (left anterior oblique view) shows a uterine pseudoaneurysm. (B) Superselective catheterization of the left uterine artery. (C) Sealing of both the pseudoaneurysm and the feeding artery is demonstrated by arteriographic control after embolization.