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MAJOR PAPERS Table of Contents   
Year : 2002  |  Volume : 12  |  Issue : 1  |  Page : 59-65
Acute and short term results transcatheter management of vaginal bleeding in gynecological and obstetric disorders


Department of cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi-110029, India

Correspondence Address:
S Sharma
Department of cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi-110029
India
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Source of Support: None, Conflict of Interest: None


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Purpose: To evaluate the safety and short-term efficacy of uterine artery embolization (UAE) in treating uncontrolled vaginal bleeding in a group of gynecologic and obstetric patients. Methods: Eighteen symptomatic patients were treated by this method. These included 11 patients with an advanced carcinoma of the cervix, three patients with uterine fibroid, three patients with a uterine arterio-venous malformation (AVM) and one patient with placenta accreta. All procedures were done by transfemoral route. Polyvinyl alcohol foam particles, 300-500 microns in size, were used for embolization. Imaging by duplex sonography was performed before the procedure and at one week and one-month follow-up. Result: Eight patient (six with carcinoma of the cervix and one each with a uterine AVM and placenta accreta) underwent unilateral and 10 patients underwent a bilateral UAE. All procedures were technically and clinically successful. Four patients developed a self-limiting post-embolization syndrome, characterized by mild fever and leucocytosis. They responded well to analgesic therapy. One patient developed a groin hematoma that resolved with conservative management. All patients reported mild to moderate pelvic pain in the post-embolization period which lasted for 24-72 hours and responded well to medication. There were no permanent sequelae of UAE. The follow-up period was 2-17 months (mean, 7 months). During follow-up, vaginal bleeding was controlled in all of them. It stopped completely in 8 and was significantly reduced in 10 patients. The size of the tumor regressed in all patients. The AVM was completely blocked in one and showed a substantially reduced flow in two patients. Conclusion: UAE is used in treating vaginal bleeding, irrespective of its etiology. The procedure is safe, produces no permanent sequelae and provides an effective control of hemorrhage. The overall complication rate is low.


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