Postpartum haemorrhage from ruptured pseudoaneurysm: efficacy of transcatheter arterial embolisation using N-butyl-2-cyanoacrylate.

Abstract

OBJECTIVES:

To evaluate the efficacy of transcatheter arterial embolisation (TAE) using N-butyl-2-cyanoacrylate (NBCA) in the treatment of postpartum haemorrhage (PPH) due to ruptured pseudoaneurysm.

METHODS:

From March 2004 to December 2010, 33 patients underwent TAE using NBCA for massive PPH. Twenty-one patients (63.6 %) were in coagulopathic condition. Angiograms and medical records were retrospectively reviewed to determine technical/clinical success, complications and recurrent haemorrhage after TAE. Telephone interviews were conducted to obtain fertility-related data.

RESULTS:

Emergent angiograms revealed ruptured pseudoaneurysms at the uterine (n = 17), vaginal (n = 14), internal pudendal (n = 3) and obturator (n = 1) arteries, which were successfully embolised with NBCA. Four patients required additional embolisation of the uterine (n = 3) or ovarian artery (n = 1) with an absorbable gelatine sponge. Adequate haemostasis was achieved in 31 patients (93.9 %) after TAE. Two patients experienced persistent (n = 1) or recurrent (n = 1) haemorrhage, which required hysterectomy. There were no major embolisation-related complications. All 29 patients who were interviewed reported regaining of their regular menstruation. Nine patients had normal pregnancies and delivered healthy babies at full term.

CONCLUSIONS:

TAE using NBCA is an effective treatment of PPH from ruptured pseudoaneurysms. In particular, NBCA is a potent embolic material in patients with coagulopathy. It does not seem to adversely affect future fertility.

KEY POINTS:

• Transcatheter arterial embolisation is a safe and effective treatment for postpartum haemorrhage. • NBCA is potent embolic material to treat bleeding patients with severe coagulopathy. • NBCA does not seem to adversely affect future fertility.

• Authors: Gyoung Min Kim, Chang Jin Yoon, Nak Jong Seong, Sung-Gwon Kang, Young-Joo Kim
• Journal: European radiology (Eur Radiol) Vol. 23 Issue 8 Pg. 2344-9 (Aug 2013) ISSN: 1432-1084 [Electronic] Germany
• PMID: 23559143 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Enbucrilate

Topics

• Adult
• Aneurysm, False (therapy)
• Angiography (methods)
• Embolization, Therapeutic (methods)
• Enbucrilate (therapeutic use)
• Female
• Hemodynamics
• Hemostasis
• Humans
• Postpartum Hemorrhage (etiology, therapy)
• Retrospective Studies
• Treatment Outcome
• Uterine Artery (pathology)
• Vagina (blood supply)
• Young Adult