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Title: Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

Abstract

PurposeWe evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.Materials and MethodsWe reviewed seven cases of patients (mean age 30.9 years; range 27–35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery’s architecture, technical and clinical success rates, and complications.ResultsThe vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.ConclusionPostpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications.more » After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.« less

Authors:
; ; ; ; ; ;  [1];  [2]; ;  [1]
  1. Kurume University School of Medicine, Department of Radiology (Japan)
  2. Kurume University School of Medicine, Department of Obstetrics and Gynecology (Japan)
Publication Date:
OSTI Identifier:
22645492
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 39; Journal Issue: 8; Other Information: Copyright (c) 2016 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ARTERIES; HEMATOMAS; HEMORRHAGE; MAPPING; PATIENTS; REVIEWS; VASCULAR DISEASES

Citation Formats

Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp, Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp, Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp, Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp, Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp, Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp, Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp, Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp, Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp, and Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration. United States: N. p., 2016. Web. doi:10.1007/S00270-016-1309-2.
Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp, Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp, Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp, Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp, Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp, Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp, Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp, Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp, Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp, & Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration. United States. doi:10.1007/S00270-016-1309-2.
Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp, Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp, Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp, Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp, Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp, Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp, Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp, Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp, Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp, and Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp. 2016. "Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration". United States. doi:10.1007/S00270-016-1309-2.
@article{osti_22645492,
title = {Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration},
author = {Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp and Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp and Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp and Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp and Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp and Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp and Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp and Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp and Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp and Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp},
abstractNote = {PurposeWe evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.Materials and MethodsWe reviewed seven cases of patients (mean age 30.9 years; range 27–35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery’s architecture, technical and clinical success rates, and complications.ResultsThe vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.ConclusionPostpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.},
doi = {10.1007/S00270-016-1309-2},
journal = {Cardiovascular and Interventional Radiology},
number = 8,
volume = 39,
place = {United States},
year = 2016,
month = 8
}
  • We present a patient with intractable postpartum hemorrhage resulting from uterine artery pseudoaneurysm despite bilateral hypogastric artery ligation who was successfully treated by an endovascular approach via the collateral route. Although there is a good argument for postponing surgery until transcatheter embolization has been attempted, this case shows that embolization can still be successful even if the iliac vessels have been ligated.
  • A 55-year-old women developed an aortointestinal fistula between the bifurcation of the aorta and the distal ileum following implantation of multiple endovascular stents into both common iliac arteries for treatment of aortoiliac occlusive disease. Ten months before the acute onset of the gastrointestinal hemorrhage two balloon-expandable steel stents had been implanted into both common iliac arteries. Due to restenosis and recurrent intermittent claudication, three balloon-expandable covered stents were implanted 4 months later on reintervention. The patient presented with abdominal pain and melena, and fell into hemorrhagic shock with signs of upper gastrointestinal bleeding. After transfer to our hospital, she againmore » developed hemorrhagic shock with massive upper and lower gastrointestinal bleeding and died during emergency laparotomy. The development of aortoenteric fistulas following endovascular surgery/stent implantation is very rare and has to be considered in cases of acute gastrointestinal hemorrhage.« less
  • Purpose. To evaluate the efficacy and safety of endovascular therapy in oral hemorrhage from malignant head and neck tumors. Methods. Ten patients (mean age 56 years) with oral hemorrhage caused by malignant head and neck tumors underwent a total of 13 emergency embolization procedures using gelatin sponge particles, steel and/or platinum coils, or a combination of these embolic materials. Angiographic abnormalities, technical success rate, clinical success rate, recurrence rate, complications, hemostatic period, hospital days, survival days, and patient outcome were all analyzed. Results. Angiographic abnormalities were identified during 85% of procedures (11/13). The technical success rate was 100% (13/13 procedures).more » The primary and secondary clinical success rates were 77% (10/13 procedures) and 67% (2/3 procedures), respectively. The overall clinical success rate was 92%, and the recurrence rate was 22% (2/9 procedures) in patients whom we were able to observe during the 1-month period after embolization. No major complications occurred. Several patients in whom gelatin sponge particles had been used complained of transient local pain after the procedure. The median hemostatic period was 71 days (range 0-518 days). Median hospital and survival days were 59 days (range 3-209 days) and 141 days (range 4-518 days), respectively. Three patients survived and 7 patients died during the observation period. Only 1 of these 7 patients died from hemorrhage. Conclusion. In conclusion, our findings suggest that endovascular therapy is an effective, safe, and repeatable treatment for oral hemorrhage caused by malignant head and neck tumors.« less
  • PurposeAcute hemorrhage associated with cancers of the head and neck is a life-threatening condition that requires immediate action. The aim of this study was to assess the safety and efficacy of endovascular embolization for acute hemorrhage in patients with head and neck cancers.Materials and MethodsData were retrospectively collected from patients with head and neck cancers who underwent endovascular embolization to treat acute hemorrhage. The primary endpoint was the rate of immediate control of hemorrhage during the first 24 h after embolization. The secondary endpoints were technical or clinical complications, rate of re-hemorrhage 24 h after the procedure, time from embolization to re-hemorrhage,more » hospitalization time, mortality rate, and time from embolization to death.ResultsFifty-one patients underwent endovascular embolization. The primary endpoint was achieved in 94% of patients. The rate of technical complications was 5.8%, and no clinical complication was observed. Twelve patients (23.5%) had hemorrhage recurrence after an average time of 127.5 days. The average hospitalization time was 7.4 days, the mortality rate during the follow-up period was 66.6%, and the average time from embolization to death was 132.5 days.ConclusionEndovascular embolization to treat acute hemorrhage in patients with head and neck cancers is a safe and effective method for the immediate control of hemorrhage and results in a high rate of hemorrhage control. Larger studies are necessary to determine which treatment strategy is best for improving patient outcomes.« less
  • We report on embolization in 36 cases of postpartum hemorrhage (PPH). The 36 patients with severe PPH, including one patient who had undergone an emergency hysterectomy, were transferred to the regional interventional vascular radiology unit in a mean time of 6 hours 12 min. Bilateral occlusion of the anterior trunk of the hypogastric arteries was carried out using gelatin sponge. Immediate success was achieved in all cases. In 3 cases, however, a second embolization was necessary before day 2. In 17%, complementary nonvascular surgery was performed. Complications included one puncture site false aneurysm treated by compression, two cases of regressivemore » lower limb paraesthesia, one femoral vein thrombosis, and nonsignificant puncture site hematomas (19.5%). Long-term follow-up was conducted in 23 patients: 91% resumed regular menstrual cycles, 8.7% dysmenorrhea. New pregnancy occurred in 13% (two full-term pregnancies and one voluntary termination). Immediate efficacy, low morbidity and preservation of fertility make embolization the technique of choice for severe PPH.« less