Precipitating hydrophobic injectable liquid (PHIL) embolic for the treatment of a uterine arteriovenous malformation: a technical report

Abstract

Objective: Uterine arteriovenous malformations (AVM) are unusual causes of vaginal bleeding. Although hysterectomy is the definitive treatment; uterine artery embolization (UAE) provides an alternative therapeutic option. This case presents a technical report of a uterine AVM treated successfully with transcatheter UAE using precipitating hydrophobic injectable liquid (PHIL) embolic agent. Case report: A 41-year-old female, gravida 6, para 4, miscarriage 2, including a molar pregnancy 15 years prior, presented with massive per vaginal bleeding. Pelvic ultrasound demonstrated an acquired AVM as the underlying aetiology for her presentation. The patient underwent bilateral uterine arterial embolization. Four weeks later, there was nearly complete resolution of the AVM and the patient's menstrual cycle was restored 8 weeks after the procedure. Conclusion: Uterine AVM can be treated safely and effectively with UAE using PHIL.

Liquid Embolic Agents for Endovascular Embolization: A Review

“…Table 1 summarizes the liquid embolics that are discussed in this review. Shear-Thinning Biomaterials [88,89] Silk Elastin Protein (SELP) [90][91][92] Poly(Ethylene Glycol) Hydrogel Embolization System (HES) Instylla Embrace [92][93][94][95][96] Eudragit [97][98][99][100] Calcium Alginate [101][102][103][104][105][106] Ethylene vinyl alcohol copolymers Squid and Squid Peri [107][108][109][110][111][112][113][114][115][116][117] Onyx Poly(lactide-co-glycolide) and poly(hydroxyethyl methacrylate) PHIL [159][160][161][162][163][164][165][166][167] Iodinated polyvinyl alcohol EASYX [168][169][170][171] 3.1. Polymerizing Liquid Embolics…”

“…The authors have suggested further studies for evaluating safety and efficacy of PHIL. In a technical report in 2019, Kurda et al demonstrated the treatment of uterine AVM by transcatheter uterine artery embolization using PHIL [165]. The authors have mentioned that the process was safe, effective and successful proving an alternative method for hysterectomy.…”