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CC BY 4.0 · Journal of Clinical Interventional Radiology ISVIR
DOI: 10.1055/s-0044-1788788
Original Article

Uterine Artery Embolization for Iatrogenic Uterine Vascular Injuries

S. Vignesh 
,
T. Mukuntharajan
2   Department of Imaging Sciences and Interventional Radiology, Meenakshi Mission Hospital & Research Centre, Madurai, Tamil Nadu, India
,
B. Madhumitha
2   Department of Imaging Sciences and Interventional Radiology, Meenakshi Mission Hospital & Research Centre, Madurai, Tamil Nadu, India
,
A. K. Kabhilan
2   Department of Imaging Sciences and Interventional Radiology, Meenakshi Mission Hospital & Research Centre, Madurai, Tamil Nadu, India
,
M. Sindhu
2   Department of Imaging Sciences and Interventional Radiology, Meenakshi Mission Hospital & Research Centre, Madurai, Tamil Nadu, India
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Abstract

Purpose Uterine curettage or surgery can lead to uterine vascular injuries such as arteriovenous malformations (AVMs) or pseudoaneurysms (PsAs), and patients may present with life-threatening uterine bleeding. The purpose of our study is to evaluate the effectiveness of uterine artery embolization (UAE) in patients with abnormal uterine bleeding due to iatrogenic vascular injuries.

Methods This is a retrospective review of 22 patients who underwent UAE at our institution between January 2019 and January 2023. Sixteen patients had a history of iatrogenic procedures. Uterine curettage was done in 12 patients, manual vacuum aspiration in 1 patient, and cesarean surgery in 3 patients. The outcomes were assessed in the form of technical feasibility, cessation of bleeding, recurrence, and pregnancy on follow-up.

Results Eighteen (18/22) patients had vascular malformations and 4 (4/22) had PsA on computed tomography. Eight patients had typical AVM features with early draining vein and 10 patients had hypertrophied vessels with no early draining veins. A total of 35 uterine arteries were embolized in 22 patients. The most commonly used embolic material was polyvinyl alcohol particles (28/35 arteries). Postembolization, bleeding symptoms subsided in 19 patients (86.4%). Three patients had recurrence of bleeding symptoms for which they underwent repeat embolization. Six patients (27%) became pregnant during the follow-up period of 15 months.

Conclusion UAE is a safe and effective treatment for iatrogenic uterine vascular injuries. This procedure allows for the preservation of uterine function with the possibility of future pregnancy and should be considered as a primary treatment option.

Keywords

uterine artery embolization - uterine arteriovenous malformation - uterine pseudoaneurysm - uterine vascular pathologies - iatrogenic - uterine - injuries

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Patient's consent was obtained during the procedures. Care has been taken not to disclose the patient's identity directly or indirectly in any form.




Publication History

Article published online:
12 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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