Diagnosis and treatment of uterine artery pseudoaneurysm

Abstract

Background: Uterine artery pseudoaneurysm (UAP) is a rare but potentially life-threatening cause of hemorrhage. Nonetheless, its knowledge could be insufficient among obstetricians, gynecologists, and radiologists. We aimed to clarify the clinical characteristics, management, and outcomes of UAP. Methods: We retrospectively analyzed nine female patients diagnosed with UAP at our institute between 2013 and 2020. Results: Seven cases presented with a history of traumatic surgery including cesarean section, dilation and curettage, laparoscopic myomectomy, and cervical conization. Two cases occurred after spontaneous vaginal delivery and second-trimester pregnancy termination. The main symptom was heavy/massive/prolonged vaginal bleeding. All patients were first evaluated by color Doppler ultrasonography and three cases were confirmed by magnetic resonance imaging. Severn patients underwent transarterial embolization (TAE) of the uterine arteries, and two were managed conservatively. All patients had good outcomes. Conclusions: UAP can develop after traumatic pelvic operations and non-traumatic delivery/abortion. It may be more common than previously considered. The risk of rupture may be correlated with multiple factors other than the mass size. TAE of the uterine artery could be an effective management strategy for ruptured UAP. However, some cases can resolve spontaneously without TAE, suggesting that conservative management can be employed in some women.

Recurrent Postpartum Hemorrhage: A Case of Uterine Artery Pseudoaneurysm Probably Induced by Anticoagulants

“…Diagnosis of UAP can be achieved through color Doppler USG, CT angiography, and magnetic resonance imaging. [ 8 ] Although color Doppler USG is the initial diagnostic modality for UAP, it may fail to reveal abnormalities, especially in cases with small-sized pseudoaneurysms, as happened in our case. [ 9 ] CT angiography is a superior diagnostic tool as it provides clear images and allows for precise localization of the aneurysm.…”

“…Several treatment options have been suggested for managing UAP, including selective transcatheter arterial embolization, ligation of the internal iliac artery, USG-guided thrombin injection, and hysterectomy. [ 8 10 ] Angiographic arterial embolization has been demonstrated as the most effective approach in managing symptomatic UAP. [ 11 ] UAE is a noninvasive and safe technique for managing postpartum bleeding, preserving reproductive potential.…”

Differential diagnosis of paracervical vascular anomalies in pregnancy

“…Its occurrence is a possible life‐threatening event both for mother and fetus. UAPs are usually the result of vascular damage incurred during gynecological surgery, both laparotomic and laparoscopic, such as myomectomy, hysterectomy, endometriosis surgery and Cesarean section, particularly when performed during labor 2 . UAPs can also occur spontaneously during pregnancy or after uncomplicated delivery.…”

Unilateral Uterine Artery Embolization Therapy For Secondary Postpartum Hemorrhage In Pseudoaneurysma Of The Sinistra Uterinary Artery Post-Cesarean Section

“…In contrast, other known causes of uterine artery pseudoaneurysms include hysterectomy and myomectomy. Vapors are rare but cannot be ruled out as a cause of delayed or secondary postpartum hemorrhage [5,6,7]. Massive hemorrhaging brought on by the rupture of a uterine artery pseudoaneurysm (UAP) can put a woman's reproductive health in peril and her life in danger, which requires an emergency laparotomy, unlike other conditions treated conservatively [7].…”

“…If other treatments fail, then the final treatment is hysterectomy. Transcatheter arterial embolization has recently emerged as a safe and highly effective alternative treatment [7]. Uterine artery pseudoaneurysms are an underreported cause of vaginal bleeding, and the incidence of bleeding emergencies due to uterine artery pseudoaneurysms is unknown.…”