Clinical Efficacy and Safety of Uterine Artery Embolization (UAE) versus Laparoscopic Cesarean Scar Pregnancy Debridement Surgery (LCSPDS) in Treatment of Cesarean Scar Pregnancy

Introduction Caesarean scar pregnancy (CSP) is a relatively rare yet life-threatening condition in which the embryo is implanted in the scar after caesarean section. Recent studies have reported that uterine artery chemoembolisation (UAC) can be safe and effective method in treating CSP. Aim To present the clinical outcome of UAC with a mixture of methotrexate and gelatine sponge for the treatment of CSP and analysis of procedural failure. Material and methods Forty-one patients diagnosed with CSP were treated with selective endovascular chemoembolisation of uterine arteries. Short- and long-term results, reasons for procedural failure, and clinical outcome were analysed. Results Primary procedure failed in 7 out of 41 (17%) cases. In 4 cases additional blood supply to the CSP was disclosed; 3 out of 4 from an ovarian artery and one from a superior vesical artery. In other 3 patients, reperfusion of uterine arteries was observed. All these 7 patients underwent successful secondary embolisation. The majority of the followed-up patients reported regular menses after the intervention. Four women suffered from amenorrhoea and 2 from hypomenorrhoea that continued after 90 days. Twelve patients expressed the desire for subsequent pregnancy. From this group, 5 conceived within a year of the procedure. The rest did not achieve a pregnancy. Conclusions UAC proved to be a safe and effective method and should be considered as an option for CSP treatment, especially for women hoping to preserve their fertility. However, the presence of collateral blood supply should always be considered.

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“…Non-surgical methods are based on the administration of MTX, whereas surgical treatments consist of removing the GS from the scar [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome and analysis of procedural failure during uterine artery chemoembolisation as a treatment of caesarean scar pregnancy.

Pyra

Szmygin

Bérczi

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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“…In 2016, the Obstetrics and Gynecology Branch of the Chinese Medical Association published the Expert Consensus on Diagnosis and Treatment of Uterine Scar Pregnancy after Cesarean Section , which determined the role of prophylactic UAE in treatment for CSP, especially for patients with CSP II/III. 11 , 14 The exact pathogenesis of CSP remains unclear. Some studies have shown that occurrence of CSP is related to scar defects after cesarean section.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for poor hemostasis of prophylactic uterine artery embolization before curettage in cesarean scar pregnancy

Tian

Jia

et al. 2020

J Int Med Res

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Objective To observe the hemostatic effect of prophylactic uterine artery embolization (UAE) in patients with cesarean scar pregnancy (CSP) and to examine the risk factors for poor hemostasis. Methods Clinical data of 841 patients with CSP who underwent prophylactic UAE and curettage were retrospectively analyzed to evaluate the hemorrhage volume during curettage. A hemorrhage volume ≥200 mL was termed as poor hemostasis. The risk factors of poor hemostasis were analyzed and complications within 60 days postoperation were recorded. Results Among the 841 patients, 6.30% (53/841) had poor postoperative hemostasis. The independent risk factors of poor hemostasis were gestational sac size, parity, embolic agent diameter (>1000 μm), multivessel blood supply, and incomplete embolization. The main postoperative complications within 60 days after UAE were abdominal pain, low fever, nausea and vomiting, and buttock pain, with incidence rates of 71.22% (599/841), 47.44% (399/841), 39.12% (329/841), and 36.39% (306/841), respectively. Conclusions Prophylactic UAE before curettage in patients with CSP is safe and effective in reducing intraoperative hemorrhage. Gestational sac size, parity, embolic agent diameter, multivessel blood supply, and incomplete embolization of all arteries supplying blood to the uterus are risk factors of poor hemostasis.

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“…It is crucial to select the appropriate size of the materials used for embolization because of the potential of breaking off during the procedure, leading to ectopic embolization ( 24 ). Therefore, the embolization process should be hyper-selective, target the vessel furthest from the lesion to avoid the remaining small co-trunk vessels, and be performed slowly under fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

Imaging features of Vertebral Aneurysmal Bone Cyst and the clinical value of interventional embolization

Zhao¹,

Xiao

et al. 2020

Exp Ther Med

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The current study aimed to investigate the imaging manifestations of vertebral aneurysmal bone cyst (ABC), and examine the clinical value of interventional embolization. Imaging examinations of 5 patients with pathologically confirmed spinal ABC were analysed and arterial angiography and embolization were performed prior to surgery. The cases in this cohort exhibited different degrees of intrusion into the vertebral arch and spinous and transverse processes. Lesions that protruded into the spinal canal resulted in compression of the thecal sac and spinal cord. Enlargement of arteries was detected by digital subtraction angiography and decreased significantly following embolization. Blood loss during surgery was also significantly reduced. Preoperative embolization of ABC reduces bleeding and allows for easy access to tissue, which is of great clinical value.

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Clinical Efficacy and Safety of Uterine Artery Embolization (UAE) versus Laparoscopic Cesarean Scar Pregnancy Debridement Surgery (LCSPDS) in Treatment of Cesarean Scar Pregnancy

Cited by 18 publications

References 22 publications

Clinical outcome and analysis of procedural failure during uterine artery chemoembolisation as a treatment of caesarean scar pregnancy.

Clinical outcome and analysis of procedural failure during uterine artery chemoembolisation as a treatment of caesarean scar pregnancy.

Risk factors for poor hemostasis of prophylactic uterine artery embolization before curettage in cesarean scar pregnancy

Imaging features of Vertebral Aneurysmal Bone Cyst and the clinical value of interventional embolization

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