Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
Eur Radiol. 2018 Nov;28(11):4800-4809. doi: 10.1007/s00330-018-5490-3. Epub 2018 May 28.
To evaluate the safety and efficacy of transcatheter arterial embolisation (TAE) managing postpartum haemorrhage associated with genital tract injury (PPH-GTI) and to determine the factors associated with clinical outcomes.
From 2002 to 2017, a retrospective analysis was performed in 60 patients (mean 31.5 years) undergoing TAE for PPH-GTI. Information regarding clinical data, angiography and embolisation details, and clinical outcomes was obtained. Univariate analyses were performed to determine the factors related to clinical outcomes.
Technical and clinical success was achieved in 98% and 88%, respectively. Bleeding foci were observed on angiography in 56 patients (93%). The major bleeding artery was the vaginal artery (32%, 24/74), followed by the uterine artery (cervicovaginal branch) (n = 18), internal pudendal artery (n = 13), cervical artery (n = 9), inferior mesenteric artery (n = 4) and external pudendal artery (n = 3). Embolic agents were gelatin sponge particles (n = 23), gelatin sponge with permanent embolic agents (microcoils, n-butyl cyanoacrylate) (n = 34) and permanent embolic agents only (n = 3). In seven patients, bleeding control failed and was managed by repeat TAE (n = 5) or surgery (n = 2) and with eventual bleeding control in all of these patients. Univariate analysis showed that paravaginal haematoma, massive transfusion and long hospital stay were related to clinical failure. During the mean follow-up period of 33.1 months, regular menstruation resumed in 95.2% (40/42) and 14 of them became pregnant.
TAE is safe and effective for treating PPH-GTI. Massive transfusion, paravaginal haematoma and long hospital stay were related to the failure of bleeding control.
• PPH-GTI had a high detection rate of active bleeding foci on angiography. • Besides vaginal artery, inferior mesenteric and external pudendal arteries were notable bleeding foci. • Permanent embolic agents were used more than only gelatin sponge particles. • Paravaginal haematoma and massive transfusion were related to clinical failure. • TAE for PPH-GTI was safe and effective with preservation of menstrual cycles.
评估经导管动脉栓塞术（TAE）治疗与生殖道损伤相关的产后出血（PPH-GTI）的安全性和疗效，并确定与临床结果相关的因素。
回顾性分析 2002 年至 2017 年期间 60 例行 TAE 治疗 PPH-GTI 的患者（平均年龄 31.5 岁）的临床资料。收集患者的临床资料、血管造影及栓塞细节和临床结局等信息。采用单因素分析确定与临床结局相关的因素。
技术成功率和临床成功率分别为 98%和 88%。56 例（93%）患者在血管造影中观察到出血灶。主要出血动脉为阴道动脉（32%，24/74），其次为子宫动脉（宫颈阴道支）（18 例）、阴部内动脉（13 例）、颈内动脉（9 例）、肠系膜下动脉（4 例）和阴部外动脉（3 例）。栓塞剂包括明胶海绵颗粒（23 例）、明胶海绵联合永久性栓塞剂（微弹簧圈、n-丁基氰基丙烯酸酯）（34 例）和单纯永久性栓塞剂（3 例）。7 例患者经重复 TAE（5 例）或手术（2 例）治疗后仍未能控制出血，最终所有患者出血均得到控制。单因素分析显示，阴道旁血肿、大量输血和住院时间长与临床失败相关。在平均 33.1 个月的随访期间，42 例患者中 95.2%（40/42）恢复了正常月经，其中 14 例患者怀孕。
TAE 治疗 PPH-GTI 安全有效。大量输血、阴道旁血肿和住院时间长与出血控制失败有关。
