Department of Radiology, Beth Israel Deaconess Medical Center, One Deaconess Rd., WCC-3, Boston, MA 02215.
Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany.
J Vasc Interv Radiol. 2019 Nov;30(11):1750-1758. doi: 10.1016/j.jvir.2019.04.002. Epub 2019 Aug 10.
To evaluate the technical and clinical success rates and safety of bilateral gelfoam uterine artery embolization (UAE) for symptomatic acquired uterine arteriovenous shunting due to prior obstetric or gynecologic event.
This was a retrospective study of consecutive patients of reproductive age who presented with abnormal uterine bleeding after recent gynecologic procedures or obstetric events between January 2013 and February 2018. Bilateral UAE was performed in all patients using gelfoam slurry. Technical success was defined as angiographic resolution of arteriovenous shunting. Clinical success was defined as cessation of symptomatic bleeding, resolution on follow-up imaging, or minimal estimated blood loss (EBL) (<50 ml) on subsequent elective dilation and curettage (D&C) procedure.
Eighteen patients (mean age, 32.8 ± 7.1 years) were included. Technical success and clinical success were experienced by 17/18 (94.4%) and 16/17 (94.1%) patients, respectively. Angiography demonstrated arteriovenous shunting in 18/18 (100%) patients, with early venous drainage. Seven of 18 (38.9%) patients underwent subsequent scheduled D&C due to remaining retained products of conception, with an EBL of 17.9 ± 15.6 ml. There was 1 minor complication of a self-limited vascular access groin hematoma (1/18, 5.6%) and 1 major complication (1/18, 5.6%) of a pulmonary embolism detected 3 days after UAE. The length of clinical follow-up was 19.3 ± 15.5 months, in which 41.2% (7/17) of the patients became pregnant.
UAE with gelfoam alone for symptomatic uterine arteriovenous shunting is a feasible treatment option that has a high technical and clinical success rate with a low rate of complications.
评估因产科或妇科事件导致的后天性子宫动静脉分流所致症状性子宫动脉明胶海绵栓塞（UAE）的技术和临床成功率及安全性。
本研究回顾性分析了 2013 年 1 月至 2018 年 2 月期间因近期妇科手术或产科事件出现异常子宫出血的育龄期连续患者。所有患者均采用明胶海绵浆行双侧 UAE。技术成功定义为血管造影显示动静脉分流得到解决。临床成功定义为症状性出血停止、随访影像学检查显示出血得到解决、或后续择期扩宫刮宫术（D&C）时估计出血量（EBL）＜50ml。
共纳入 18 例患者（平均年龄 32.8±7.1 岁）。17/18 例（94.4%）患者实现了技术成功，16/17 例（94.1%）患者实现了临床成功。18 例患者的血管造影均显示动静脉分流，且早期静脉引流。18 例患者中有 7 例（38.9%）因仍有妊娠组织残留而行后续计划 D&C，EBL 为 17.9±15.6ml。18 例患者中发生 1 例轻微并发症（血管通路腹股沟血肿，1/18，5.6%）和 1 例严重并发症（肺栓塞，1/18，5.6%），均于 UAE 后 3 天发现。临床随访时间为 19.3±15.5 个月，其中 17 例患者的 41.2%（7/17）成功妊娠。
UAE 联合明胶海绵治疗症状性子宫动静脉分流是一种可行的治疗方法，具有较高的技术和临床成功率，并发症发生率较低。
