Interventional radiology and endovascular surgery in the treatment of ectopic pregnancies

Abstract

The advent of interventional radiology enabled remarkable advances in diagnosis and treatment of several situations in obstetrics and gynecology. In the field of obstetrics, these advances include temporary occlusion of the iliac arteries to the management of placenta accreta and/or prior, arteriovenous fistulas after embolization of uterine curettage and management of ectopic uterine and extra-uterine pregnancies. The non-tubal ectopic pregnancy, either cervical, abdominal, ovarian or in a cesarean scar, often represents major therapeutic challenge, especially when exists a desire to maintain fertility. Despite the systemic methotrexate therapy and surgical resection of the ectopic gestational sac be the most used therapeutic options, the interventionist approach of non-tubal ectopic pregnancies, direct injection of methotrexate in the gestational sac and intra-arterial chemoembolization of uterine arteries constitute in the currently literature viable, safe, effective modalities with low morbidity, shorter hospital stay, and rapid clinical recovery. Because of little variety of materials used, and the increase in training of specialists in the area, the radiological intervention as a treatment option in ectopic pregnancies is financially viable and present considerable accessibility in the world and at most of Brazilian medical centers.

Endovascular Therapy for Abdominal Pregnancy

“…While less common, intraarterial targeted embolization of nontubal ectopic pregnancies has also been described. 6,7 Similar to our case, a few reports detail cases with successful placental embolization specific to abdominal ectopic pregnancy. 8,9 Our case contributes to this body of data, with postembolization imaging demonstrating a dramatic decrease in blood flow to the abnormally located placenta.…”

Management of non-tubal ectopic pregnancies at a large tertiary hospital

“…Whilst certain cases may be managed on an outpatient basis, there are risks of late rupture with low levels of detectable HCG and/or resolving but persisting ectopic mass as reflected in our algorithm (Figure 1). Finally, we have presented our local experience, which dichotomized surgical and medical therapies, but there are also reports of radiologically guided vessel embolisation that may be of benefit in centres with the available expertise, as an alternative non-operative strategy (Fornazari et al, 2015).…”

Successful Treatment of Interstitial Ectopic Pregnancy Using Courses of Methotrexate and Folinic Acid Rescue: A Case Report

“…A diverse array of alternative treatments has been introduced over the last three decades, with the common goal of achieving a minimally invasive, standardized management strategy. 13 Some conservative surgical treatment options such as laparoscopically assisted transcervical suction evacuation, laparoscopically assisted hysteroscopic removal of an IP, 14 and intraarterial chemoembolization of the uterine artery 15 have been reported.…”