Prompt Diagnosis and Treatment of Uterine Arcuate Artery Pseudoaneurysm: A Case Report and Review of Literature

Sharma, Nidhi; Ganesh, Deepa; Devi, Lakshmi A.; Srinivasan, Jayashree; Ranga, Upasana

doi:10.7860/jcdr/2013/6063.3506

Cited by 13 publications

(13 citation statements)

References 12 publications

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“…In such cases, endovascular treatment is often the first-line therapy. Embolization can be achieved with coils, stents and injectable liquids [9,10], and offers the potential of preserving fertility for the patient. However, in the literature, the pseudoaneurysms treated successfully by this method were only 0.6–3.5 cm in diameter [11].…”

Section: Discussionmentioning

confidence: 99%

Giant uterine artery pseudoaneurysm after a missed miscarriage termination in a cesarean scar pregnancy

Mou

2014

BMC Women's Health

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BackgroundUterine artery pseudoaneurysms are dangerous and can lead to severe hemorrhage. We report an uncommon cause of a giant pseudoaneurysm in a missed miscarriage in a woman with a cesarean scar pregnancy.Case presentationThe patient was a 25-year-old Chinese woman with a missed miscarriage in a cesarean scar pregnancy. Curettage was performed under ultrasound monitoring. A uterine artery pseudoaneurysm measuring 71 × 44 × 39 mm was detected the next day by Doppler ultrasonography. While waiting for admittance to an advanced institution to undergo embolization treatment, the pseudoaneurysm ruptured spontaneously. The subsequent severe hemorrhage necessitated hysterectomy.ConclusionA delay in diagnosis of uterine artery pseudoaneurysms may result from a long period between the curettage and follow-up examination. Ultrasound and Doppler ultrasonography should be performed repeatedly at short intervals to rule out them, especially in cesarean scar pregnancies. For a giant uterine artery pseudoaneurysm, interventional embolization might be the first treatment choice. If time allows, intra-operative ligation of the feeding vessels should be attempted before any decision to perform a hysterectomy is made. However, hysterectomy remains a possibility when severe bleeding occurs.

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Section: Discussionmentioning

confidence: 99%

Giant uterine artery pseudoaneurysm after a missed miscarriage termination in a cesarean scar pregnancy

Mou

2014

BMC Women's Health

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“…Of the 25 cases to date, the main choice for pelvic vascular intervention was uterine artery, so the occurrence of pseudoaneurysm after obstetric vascular interventional treatment was mainly seen in uterine arteries, which occurred more in the left side than in the right side. [ 14 – 16 ] Though occasionally reported in the internal iliac artery, [ 17 ] multiple pseudoaneurysms occurred in CIA was rarely reported. Rupture of pseudoaneurysm in uterine arteries of the patients in the past case reports were mainly manifested with vaginal bleeding, abdominal pain, PPH, and one case with hemorrhagic shock.…”

Section: Discussionmentioning

confidence: 99%

Rupture of multiple pseudoaneurysms as a rare complication of common iliac artery balloon occlusion in a patient with placenta accreta

Peng

Zhang

2018

Medicine

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Rationale:Placenta accreta is the main cause of severe obstetric postpartum hemorrhage (PPH) and hysterectomy. Several hemostatic techniques have been performed in patients with placenta accreta to prevent PPH and reserve fertility. Abdominal aorta and pelvic arteries balloon occlusion are the only techniques which could be performed before cesarean section (CS) in patients who want to keep the fetus and reserve fertility. However, abdominal aorta and pelvic arteries balloon occlusion might lead to severe complications such as formation and rupture of pseudoaneurysm, angiorrhexis, etc.Patient concerns:We report a case diagnosed with pernicious placenta previa (PPP) combined with Rh(D) negative blood type, who was performed with bilateral common iliac arteries (CIA) balloon occlusion during CS. However, on the first day after CS, the patient caught sudden left-side lumbago and backache accompanied with palpitation and shortness of breath.Diagnoses:Formation and rupture of multiple pseudoaneurysms in left CIA.Interventions:Covered stent was inserted into the proximal part of the left CIA and the ipsilateral internal iliac artery was embolized by coil to prevent endoleak.Outcomes:The patient recovered and discharged from hospital in stable condition without other complications 9 days after CS.Lessons:It is of paramount importance that obstetricians and radiologists correctly estimate the appropriate occlusion volume and pressure of pelvic arteries before CS to avoid formation and rupture of a pseudoaneurysm. And if the rupture of a pseudoaneurysm occurred, it should be quickly identified and treated with endovascular intervention.

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“…Hence, bilateral uterine embolisation is safe and more advantageous than unilateral embolisation. [3,9] Uterine artery embolisation has become an effective and safe treatment for postpartum haemorrhage, allowing the preservation of reproductive function. Recent reports described the use of a thrombin injection directly into the pseudoaneurysm under ultrasound guidance, as a substitute for arterial embolisation; however, its indications and effectiveness have not yet been determined.…”

Section: Discussionmentioning

confidence: 99%

“…We present a case of a uterine artery PA presenting as delayed postpartum haemorrhage. [3] Case report…”

Section: Corresponding Author: S Barahmeh (Samersalman2@yahoocom)mentioning

confidence: 99%

Secondary postpartum haemorrhage with uterine artery pseudoaneurysm after caesarean section, managed with uterine artery embolisation

Barahmeh¹,

Edwan²

2017

S Afr J OG

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CASE REPORTUterine artery pseudoaneurysm (PA) is a rare but serious complication of caesarean section (C/S). If inadequately treated, it can lead to life-threatening postpartum haemorrhage. We report the case of a 28-year-old woman who developed secondary postpartum haemorrhage resulting from uterine artery PA after C/S. Angiographic embolisation is a safe and effective procedure for treating postpartum haemorrhage resulting from PA in haemodynamically stable patients. However, uterine artery ligation may be the surgical procedure of choice for haemodynamically unstable patients when preservation of fertility is desired. Pseudoaneurysm (PA) of the uterine artery is an uncommon cause of delayed postpartum haemorrhage following cesarean section (C/S) or vaginal delivery. This condition may result in secondary postpartum haemorrhage, which is defined as haemorrhage that occurs between 24 hours, and 6 and 12 weeks postpartum. S Afr J Obstet Gynaecol[1] Although a diagnosis of retained gestational products or endometritis should be considered initially, a diagnosis of PA of the uterine artery and caesarean scar dehiscence should be considered after ruling out disseminated intravascular coagulation as a possible diagnosis when a patient presents with massive uterine bleeding without any associated symptoms, such as fever and tenderness, or subinvolution of the uterus. [2] Haematoma formation involving the uterine artery is the main suggested mechanism associated with PA of the uterine artery. After haematoma formation, there is central liquefaction that leaves a cavity with turbulent blood flow as a result of persistent communication between the parent artery and the hematoma. A uterine artery PA develops when the uterine artery is lacerated or injured in a way that would breach the integrity of the three-layer arterial wall lining. While maintaining contact with the parent vessel, extravasating blood dissects through the tissues, finally establishing a connection with the uterine cavity, which causes a delayed haemorrhage. The boundaries of a false aneurysm are constituted by thrombus, as opposed to the three arterial layers as in a true aneurysm. Although Doppler ultrasound can aid in the assessment, uterine artery angiography is necessary to make the diagnosis and provides the subsequent means for embolisation. We present a case of a uterine artery PA presenting as delayed postpartum haemorrhage.[3] Case reportA 28-year-old para 3 was transferred to our institution at 27 days post operation with symptoms of excessive bleeding per vagina. She had undergone an elective low transverse segment C/S delivery for breech presentation at a gestational age of 39 weeks at another hospital. Her intraoperative course was smooth and uneventful, and the estimated blood loss was ~600 mL. Her postoperative course was also uncomplicated until day 13 postoperatively.On postoperative day 13, she was readmitted to the same hospital for management of a delayed postpartum haemorrhage, which had developed abruptly with no previous history...

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Prompt Diagnosis and Treatment of Uterine Arcuate Artery Pseudoaneurysm: A Case Report and Review of Literature

Cited by 13 publications

References 12 publications

Giant uterine artery pseudoaneurysm after a missed miscarriage termination in a cesarean scar pregnancy

Giant uterine artery pseudoaneurysm after a missed miscarriage termination in a cesarean scar pregnancy

Rupture of multiple pseudoaneurysms as a rare complication of common iliac artery balloon occlusion in a patient with placenta accreta

Secondary postpartum haemorrhage with uterine artery pseudoaneurysm after caesarean section, managed with uterine artery embolisation

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