Uterine Artery Embolization with Gelfoam for Acquired Symptomatic Uterine Arteriovenous Shunting

• Published in: Journal of vascular and interventional radiology Vol. 30; no. 11; pp. 1750 - 1758
• Main Authors: Camacho, Andrés, Ahn, Edward H., Appel, Elisabeth, Boos, Johannes, Nguyen, Quang, Justaniah, Almamoon I., Faintuch, Salomao, Ahmed, Muneeb, Brook, Olga R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2019
• Subjects: Abortion, Induced - adverse effects; Adult; Dilatation and Curettage; Female; Fertility; Gelatin Sponge, Absorbable - administration & dosage; Gelatin Sponge, Absorbable - adverse effects; Humans; Middle Aged; Postpartum Hemorrhage - diagnostic imaging; Postpartum Hemorrhage - etiology; Postpartum Hemorrhage - therapy; Pregnancy; Retrospective Studies; Risk Factors; Time Factors; Time-to-Pregnancy; Treatment Outcome; Uterine Artery Embolization - adverse effects; Uterine Artery Embolization - methods; Uterine Hemorrhage - diagnostic imaging; Uterine Hemorrhage - etiology; Uterine Hemorrhage - therapy; Young Adult; D&C; RPOC; AV; MR; UAE; PVA; EBL
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2019.04.002

To evaluate the technical and clinical success rates and safety of bilateral gelfoam uterine artery embolization (UAE) for symptomatic acquired uterine arteriovenous shunting due to prior obstetric or gynecologic event. This was a retrospective study of consecutive patients of reproductive age who presented with abnormal uterine bleeding after recent gynecologic procedures or obstetric events between January 2013 and February 2018. Bilateral UAE was performed in all patients using gelfoam slurry. Technical success was defined as angiographic resolution of arteriovenous shunting. Clinical success was defined as cessation of symptomatic bleeding, resolution on follow-up imaging, or minimal estimated blood loss (EBL) (<50 ml) on subsequent elective dilation and curettage (D&C) procedure. Eighteen patients (mean age, 32.8 ± 7.1 years) were included. Technical success and clinical success were experienced by 17/18 (94.4%) and 16/17 (94.1%) patients, respectively. Angiography demonstrated arteriovenous shunting in 18/18 (100%) patients, with early venous drainage. Seven of 18 (38.9%) patients underwent subsequent scheduled D&C due to remaining retained products of conception, with an EBL of 17.9 ± 15.6 ml. There was 1 minor complication of a self-limited vascular access groin hematoma (1/18, 5.6%) and 1 major complication (1/18, 5.6%) of a pulmonary embolism detected 3 days after UAE. The length of clinical follow-up was 19.3 ± 15.5 months, in which 41.2% (7/17) of the patients became pregnant. UAE with gelfoam alone for symptomatic uterine arteriovenous shunting is a feasible treatment option that has a high technical and clinical success rate with a low rate of complications.