Leleup Grégoire, Fohlen Audrey, Dohan Anthony, Bryan-Rest Lara, Le Pennec Vincent, Limot Olivier, Le Dref Olivier, Soyer Philippe, Pelage Jean-Pierre
Department of Diagnostic Imaging and Interventional Radiology, Centre Hospitalier Universitaire de Caen, Normandie University, Caen, France.
Department of Diagnostic Imaging and Interventional Radiology, Centre Hospitalier Universitaire de Caen, Normandie University, Caen, France; Imagerie et Stratégie Thérapeutique des Pathologies Cérébrales et Tumorales, Normandie University, UNICAEN, CEA, Centre National de la Recherche Scientifique, ISTCT, Caen, Caen, France.
J Vasc Interv Radiol. 2017 May;28(5):696-701. doi: 10.1016/j.jvir.2017.01.016. Epub 2017 Mar 11.
To evaluate the feasibility and efficacy of embolization of the round ligament arteries in the management of postpartum hemorrhage.
Eleven women (mean age, 31 y) underwent round ligament artery because of persistent or recurrent hemorrhage after initial uterine or internal iliac artery embolization.
A total of 16 round ligament arteries were embolized. The round ligament artery arose from the inferior epigastric artery in 11 cases (69%) and directly from the external iliac artery in 5 (31%). Embolization was performed with calibrated microspheres in 7 women (63%) and gelatin sponge pledgets in 4 (37%). Coils were used in addition to gelatin sponge pledgets in 3 patients. Hemostasis was achieved in 10 patients (91%), and 1 required additional conservative surgery. The mean hemoglobin level before embolization was 7.2 g/dL ± 1 and increased significantly on day 1 after embolization (10.3 g/dL ± 1.0; P < .05). No procedure-related complication was reported. The mean hospital stay was 5.6 days ± 2. Two patients had further pregnancies 13 and 14 months after embolization.
Selective embolization of the round ligament artery is a safe and effective treatment for obstetric hemorrhage. It should be considered in cases of persistent or recurrent bleeding after initial uterine or internal iliac artery embolization.
评估圆韧带动脉栓塞术在产后出血治疗中的可行性和疗效。
11名女性（平均年龄31岁）因初次子宫或髂内动脉栓塞术后持续或反复出血而接受圆韧带动脉栓塞术。
共栓塞16条圆韧带动脉。11例（69%）圆韧带动脉起自腹壁下动脉，5例（31%）直接起自髂外动脉。7名女性（63%）使用校准微球进行栓塞，4名（37%）使用明胶海绵小块。3例患者除明胶海绵小块外还使用了弹簧圈。10例患者（91%）实现止血，1例需要额外的保守手术。栓塞术前平均血红蛋白水平为7.2 g/dL±1，栓塞术后第1天显著升高（10.3 g/dL±1.0；P<.05）。未报告与手术相关的并发症。平均住院时间为5.6天±2天。2例患者在栓塞术后13个月和14个月再次怀孕。
圆韧带动脉选择性栓塞术是治疗产科出血的一种安全有效的方法。对于初次子宫或髂内动脉栓塞术后持续或反复出血的病例应考虑采用该方法。
