Postpartum hemorrhage from extravasation or pseudoaneurysm: efficacy of transcatheter arterial embolization using N-butyl cyanoacrylate and comparison with gelatin sponge particle.

Abstract

PURPOSE:

To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) using N-butyl cyanoacrylate (NBCA) for the treatment of active postpartum hemorrhage (PPH) and compare the efficacy of NBCA with gelatin sponge particles.

MATERIALS AND METHODS:

From January 2004 to September 2013, 26 patients with PPH underwent TAE using NBCA as the primary embolic material. All patients were actively bleeding, and 12 (46.2%) had coagulopathy. TAE was performed using 1:2-1:4 mixtures of NBCA and ethiodized oil with or without use of a coil or gelatin sponge. To compare the efficacy of NBCA with conventional embolic material, 50 patients with active bleeding who underwent TAE using gelatin sponge were also analyzed.

RESULTS:

Angiograms demonstrated pseudoaneurysm or extravasation or both. The technical and clinical success rates were 100% and 92.3% (24 of 26 patients), respectively, for NBCA and 98% and 86.0% (43 of 50 patients), respectively, for gelatin sponge. In the NBCA group, one patient recovered with conservative management, and the other patient died because of multiorgan dysfunction. There were no major or minor procedure-related complications.

CONCLUSIONS:

TAE using NBCA as the primary embolic agent is an effective method for treating PPH with extravasation or pseudoaneurysm; NBCA is comparable to gelatin sponge particles. TAE using NBCA seems to fill pseudoaneurysms and make devascularization more effective than using gelatin sponge.

• Authors: Kye Jin Park, Ji Hoon Shin, Hyun-Ki Yoon, Dong-Il Gwon, Gi-Young Ko, Kyu-Bo Sung
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 26 Issue 2 Pg. 154-61 (Feb 2015) ISSN: 1535-7732 [Electronic] United States
• PMID: 25454736 (Publication Type: Controlled Clinical Trial, Journal Article)
• Copyright: Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Chemical References

• Hemostatics
• Enbucrilate

Topics

• Adult
• Aneurysm, False (complications, diagnostic imaging, therapy)
• Chemoembolization, Therapeutic (methods)
• Enbucrilate (therapeutic use)
• Female
• Gelatin Sponge, Absorbable (therapeutic use)
• Hemostatics (therapeutic use)
• Humans
• Middle Aged
• Postpartum Hemorrhage (diagnostic imaging, etiology, therapy)
• Pregnancy
• Radiography, Interventional (methods)
• Treatment Outcome