Inferior mesenteric artery embolization for persistent postpartum hemorrhage after sufficient bilateral iliac arteries embolization: safety and efficacy in eight patients

Transcatheter Uterine Artery Embolisation in Treating Secondary Haemorrhage Post Hysterectomy: A Life-Saving Approach

Hysterectomy, which is a surgical procedure to remove all or a part of the uterus, is one of the most commonly done procedures by a gynaecologist. However, it may be associated with a number of complications. Haemorrhage following hysterectomy is a life-threatening complication. One of the most common complications is haemorrhage, whether primary or secondary. The various options to treat secondary haemorrhage post hysterectomy are uterine artery embolization (UAE) or surgical re-exploration. Here, we present a case of secondary haemorrhage post hysterectomy treated with uterine artery embolization and describe the numerous advantages of UAE as a novel approach to stop bleeding post hysterectomy over the traditional surgical re-exploration method.

Two Case Studies on Inferior Mesenteric Artery Embolization for Primary Postpartum Hemorrhage

Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality. Transcatheter arterial embolization (TAE) is an effective treatment option for PPH. Among the vessels embolized, the inferior mesenteric artery (IMA) is usually not the first choice for TAE, because it is a rare source of bleeding in PPH. In this report, we describe our experience with two patients with PPH, in whom the IMA was selected on the basis of contrast-enhanced computed tomography (CECT) findings, and prompt hemostasis was achieved with TAE. CECT can provide useful clues as to the culprit artery based on the anatomical location of the hematoma and extravasation. These useful findings of CECT allow prompt TAE of rare sources of bleeding in PPH, such as the IMA.

Efficacy of superselective transcatheter arterial embolization for intractable postpartum hemorrhage due to genital tract trauma after vaginal delivery

Purpose

To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery.

Methods

We evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups.

Results

The combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003).

Conclusion

S-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.

Testicular artery originating from the inferior mesenteric artery: an alert for interventionalists - A case report

Testicular arteries usually arise from the abdominal aorta. During an elective embolization of superior rectal arteries for hemorrhoidal disease performed in a 52-year-old male patient, a previously unreported vascular variant was identified. On selective angiography, the inferior mesenteric artery split into left colic artery and left testicular artery, without any evidence of vascular supply to the hemorrhoidal cushions. Superior rectal arteries were embolized after catheterization of the median sacral artery. A thorough knowledge of vascular variations is essential for interventional radiologists in order to recognize them and avoid potential complications.

Inferior Mesenteric Artery Embolization with N-Butyl Cyanoacrylate for Life-Threatening Postpartum Hemorrhage: A Report of Two Cases and Literature Review

하장간막동맥은 산후출혈의 매우 드문 출혈 혈관이다. 저자들은 질분만 후 하장간막동맥에서 출혈이 있었던 일차성 산후출혈 두 개의 증례를 보고한다. 두 환자 모두 저혈량성 쇼크의 징후를 보이고 있었고, 파종성혈관내응고가 의심되는 상태였다. 산후출혈의 흔한 출혈 혈관인 자궁동맥을 색전한 후에도 출혈은 지속되었다. 하장간막동맥 혈관조영술에서 상직장동맥으로부터 조영제의 혈관외누출이 확인되어 N-butyl cyanoacrylate를 이용한 선택적 색전술을 시행하였다. 이 증례를 통해 산도 손상에 의한 산후출혈이 조절되지 않고 지속될 때 하장간막동맥이 출혈 동맥일 수 있다는 점을 강조하고자 한다.