Uterine Artery Embolization as a Uterine-Sparing Solution for Postpartum Pseudoaneurysms

Background: Uterine artery pseudoaneurysm (UAP) is an under-recognized source of postpartum hemorrhage, with high morbidity and mortality. UAP has been historically managed with hysterectomy. Uterine artery embolization (UAE) is a minimally invasive and uterine-preserving option for this condition. This retrospective cohort study evaluated the clinical and technical efficacy of UAP embolization, and the utility of UAE for avoiding hysterectomy. Case: A cohort of 5 patients who underwent a total of 6 UAEs between January 2000 and June 2017 at a single institution was assessed. Inclusion criteria included imaging-confirmed UAP and that the patient had undergone UAE. Electronic medical records and angiographic images were assessed for patient presentations and demographics, intraprocedural details, and short-term follow-up outcomes. Results: This cohort included post-traumatic UAP inpatients who had granulomatosis with polyangiitis or Ehler-Danlos syndrome. UAE produced 100% clinical success (cessation of vaginal bleeding and averting hysterectomy). Technical success (angiographic stasis) was achieved in 4 of 5 patients. No major treatment-related complications occurred. Conclusion: UAP is an underestimated cause of postpregnancy hemorrhage, which is historically managed by hysterectomy. Clinicians should have a high index of suspicion for UAP particularly in patients with vasculitis and connective-tissue disease. UAE is an effective uterine-preserving treatment option for postpregnancy patients bleeding from pseudoaneurysms. It offers a viable choice for women who desire future pregnancies.