Background: Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide. Delayed PPH has received less attention compared to early PPH because the incidence rate of delayed PPH is relatively lower than that of early PPH. Objectives: The aim of this study was to evaluate the clinical manifestations, angiographic findings, and effectiveness of selective transcatheter arterial embolization (TAE) for delayed PPH. Patients and Methods: Selective TAE was performed on 37 women (mean age: 32.1 years, range: 24-40) with delayed PPH between March 2006 and October 2016. Delayed PPH was defined as continuous hemorrhage from the female genital tract 24 hours to 6 weeks after delivery. Medical records were retrospectively reviewed for patient characteristics, the time interval between delivery and TAE, angiographic findings, embolized artery, embolic materials, technical and clinical success rate, and complications. Results: Delayed bleeding developed at a median 11.6 days (range: 2-34 days) after cesarean section (n = 19) and vaginal delivery (n = 18). On angiography, diffuse hypervascularity was detected in 24 patients, pseudoaneurysm in 11, active extravasation in 1, and arteriovenous malformation in 1. Arteries subjected to TAE included bilateral uterine arteries (UAs) (n = 29), bilateral UAs and unilateral ovarian artery (OA) (n = 4), bilateral UAs and bilateral OAs (n = 1), bilateral UAs and cervicovaginal branch (n = 1), unilateral OA (n = 1), and internal pudendal artery (n = 1). Embolic materials were Gelfoam (n = 30), Gelfoam and coil (n = 3), polyvinyl alcohol (PVA) (n = 2), and PVA and coil (n = 2). There were no procedure-related major complications. Technical success was obtained in all patients (100%), and clinical success was obtained in 34 patients (91.9%) Conclusion: Selective TAE in patients with delayed PPH is a useful treatment with high technical and clinical success.
The radiologic placement of uncovered stents for the treatment of malignant obstruction proximal to the descending colon is feasible and safe, and provides acceptable clinical results.
A 61-year-old man presented to our hospital with abdominal pain and melena. He showed no obvious source of bleeding on gastroduodenoscopy. Computed tomography and conventional angiography revealed a huge aneurysm arising from the common hepatic artery. The aneurysm was embolized using coils. The procedure was uncomplicated, and the patient was discharged from the hospital 5 days after admission. Herein, we present the case of a rare huge hepatic artery aneurysm (5.7 × 6.0 cm in size) that caused abdominal pain and upper gastrointestinal bleeding.
It is essential to identify the causative artery in case of active intra-abdominal or gastrointestinal bleeding. A thorough understanding of the basic arterial anatomy is required to identify the causative artery on contrast-enhanced CT angiography and conventional catheter angiography. If one is familiar with the basic arterial anatomy, obtaining access to the bleeding artery will be easier, despite the variations in the origin and course of the vessels. We describe the basic arterial anatomy that will help beginners in diagnostic radiology to identify the blood vessels that can cause active intra-abdominal or gastrointestinal bleeding.
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