Postpartum haemorrhage from ruptured pseudoaneurysm: efficacy of transcatheter arterial embolisation using N-butyl-2-cyanoacrylate

• Published in: European radiology Vol. 23; no. 8; pp. 2344 - 2349
• Main Authors: Kim, Gyoung Min, Yoon, Chang Jin, Seong, Nak Jong, Kang, Sung-Gwon, Kim, Young-Joo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2013; Springer Nature B.V
• Subjects: Adult; Aneurysm, False - therapy; Angiography - methods; Blood transfusions; Diagnostic Radiology; Embolization; Embolization, Therapeutic - methods; Enbucrilate - therapeutic use; Female; Fertility; Hemodynamics; Hemorrhage; Hemostasis; Humans; Imaging; Infertility; Intensive care; Internal Medicine; Interventional; Interventional Radiology; Ischemia; Medical records; Medicine; Medicine & Public Health; Neuroradiology; Obstetrics; Polyvinyl alcohol; Postpartum Hemorrhage - etiology; Postpartum Hemorrhage - therapy; Pseudoaneurysm; Radiology; Retrospective Studies; Treatment Outcome; Ultrasound; Uterine Artery - pathology; Vagina - blood supply; Veins & arteries; Young Adult; Postpartum haemorrhage; Transcatheter arterial embolisation; N-butyl-2-cyanoacrylate; Ruptured pseudoaneurysm; Coagulopathy
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-013-2830-1

Objectives To evaluate the efficacy of transcatheter arterial embolisation (TAE) using N-butyl-2-cyanoacrylate (NBCA) in the treatment of postpartum haemorrhage (PPH) due to ruptured pseudoaneurysm. Methods From March 2004 to December 2010, 33 patients underwent TAE using NBCA for massive PPH. Twenty-one patients (63.6 %) were in coagulopathic condition. Angiograms and medical records were retrospectively reviewed to determine technical/clinical success, complications and recurrent haemorrhage after TAE. Telephone interviews were conducted to obtain fertility-related data. Results Emergent angiograms revealed ruptured pseudoaneurysms at the uterine ( n  = 17), vaginal ( n  = 14), internal pudendal ( n  = 3) and obturator ( n  = 1) arteries, which were successfully embolised with NBCA. Four patients required additional embolisation of the uterine ( n  = 3) or ovarian artery ( n  = 1) with an absorbable gelatine sponge. Adequate haemostasis was achieved in 31 patients (93.9 %) after TAE. Two patients experienced persistent ( n  = 1) or recurrent ( n  = 1) haemorrhage, which required hysterectomy. There were no major embolisation-related complications. All 29 patients who were interviewed reported regaining of their regular menstruation. Nine patients had normal pregnancies and delivered healthy babies at full term. Conclusions TAE using NBCA is an effective treatment of PPH from ruptured pseudoaneurysms. In particular, NBCA is a potent embolic material in patients with coagulopathy. It does not seem to adversely affect future fertility. Key Points • Transcatheter arterial embolisation is a safe and effective treatment for postpartum haemorrhage. • NBCA is potent embolic material to treat bleeding patients with severe coagulopathy. • NBCA does not seem to adversely affect future fertility.