03:27 PM Abstract No. 134 Superior hypogastric nerve block for post-procedure pain control after uterine artery embolization

Abstract

Purpose: To determine the safety and efficacy of ultrasound (US)guided direct puncture for ethylene vinyl alcohol copolymer (EVOH) embolization in the treatment of uterine arteriovenous fistulas (UAVFs). Materials: A retrospective review of consecutive female patients treated for UAVFs from July 2015 to August 2018 was performed. Patient histories, laboratory values, imaging studies, and follow up clinic notes were reviewed. A total of 4 patients were included; median age was 28 years (range: 24-33). All patients had history of uterine instrumentation and presented with life-threatening vaginal bleeding with an UAVF visible on US or MRI. Two (50%) had previously undergone proximal uterine artery embolization (UAE) but had recurrent bleeding. US-guided direct UAVF puncture was performed by transabdominal (n¼2) or transvaginal (n¼2) approach with injection of EVOH in all patients (a detachable coil scaffold was deployed in the first case but was not necessary in subsequent cases). After the fistulous connection had been successfully closed, Gelfoam UAE was performed to stasis. Technical success was defined by resolution of UAVF on intraprocedural angiography/US and follow up MRI. Clinical success was defined as resolution of the bleeding without recurrence or need for other therapies. Results: Technical success was 100%. Angiography after obliteration of the fistulous connection with EVOH showed elimination of rapid filling of outflow veins in all cases and allowed for safe Gelfoam UAE. Follow up MRI showed EVOH filling the previously seen dilated vascular channels in all cases. Clinical success was 100% with resolution of bleeding in all patients; average follow up duration 395 days (range: 32 -1,123 days). All patients tolerated the procedure well without immediate or delayed complication at 1 year. A 24-year old patient was 19 weeks pregnant at the time of data collection. Conclusions: US-guided direct puncture for EVOH delivery prior to Gelfoam UAE is a safe and effective option for management of UAVFs, avoiding hysterectomy and preserving the option of fertility in young women.