Mathieu Eliott, Riethmuller Didier, Delouche Aurélie, Sicot Marie, Teyssier Yann, Finas Mathieu, Guillaume Bénédicte, Thony Frederic, Ferretti Gilbert, Ghelfi Julien
University of Grenoble Alpes, Grenoble, France; Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France.
University of Grenoble Alpes, Grenoble, France; Department of Obstetrics and Gynecology, Grenoble Alpes University Hospital, Grenoble, France.
J Vasc Interv Radiol. 2022 Nov;33(11):1313-1320. doi: 10.1016/j.jvir.2022.07.018. Epub 2022 Jul 19.
To evaluate the effectiveness and safety of temporary proximal uterine artery embolization (UAE) for the treatment of highly vascularized retained products of conception (RPOCs).
This retrospective analysis included women who underwent treatment for vaginal bleeding after abortion, miscarriage, or delivery, with highly vascularized RPOCs detected by Doppler ultrasound (US) (ie, presence of an enhanced myometrial vascularity, a low resistance index of <0.5, and a peak systolic velocity of ≥0.7 m/s). A unilateral or bilateral embolization with torpedoes of gelatin foam was performed. From November 2017 to January 2021, 24 women with a median age of 30 years (interquartile range, 26.0-34.5 years) with symptomatic highly vascularized RPOCs were included. Clinical success was defined as bleeding arrest between the UAE and 1-month follow-up. Technical success was defined as the complete obstruction of at least 1 uterine artery supplying vascular abnormalities. The safety of the procedure according to the classification of the Society of Interventional Radiology and evolution of lesions on US were also reported.
Technical success was achieved in all 24 (100%) patients, with bilateral arterial embolization in 19 (79%) patients and unilateral embolization in 5 (21%) patients. Clinical success was achieved in all 24 (100%) patients. Five patients still had uterine retention at the 1-month follow-up, including 2 patients with highly vascularized RPOCs. Two patients benefited from hysteroscopy, and 3 had noninvasive management. Four minor adverse events were reported (1 patient had infectious endometritis and 3 patients had a postembolization syndrome).
Proximal UAE with torpedoes of gelatin foam is safe and effective for the management of symptomatic highly vascularized RPOCs.
评估暂时性子宫动脉近端栓塞术（UAE）治疗高血管化妊娠物残留（RPOC）的有效性和安全性。
本回顾性分析纳入了因流产、自然流产或分娩后阴道出血而接受治疗的女性，这些女性经多普勒超声（US）检测出高血管化RPOC（即子宫肌层血管增强、阻力指数<0.5且收缩期峰值流速≥0.7 m/s）。采用明胶海绵条进行单侧或双侧栓塞。2017年11月至2021年1月，纳入了24例中位年龄为30岁（四分位间距为26.0 - 34.5岁）、有症状的高血管化RPOC患者。临床成功定义为UAE后至1个月随访期间出血停止。技术成功定义为至少1条供应血管异常的子宫动脉完全阻塞。还报告了根据介入放射学会分类的手术安全性以及US上病变的演变情况。
所有24例（100%）患者均取得技术成功，其中19例（79%）患者进行了双侧动脉栓塞，5例（21%）患者进行了单侧栓塞。所有24例（100%）患者均取得临床成功。5例患者在1个月随访时仍有子宫残留，其中2例为高血管化RPOC。2例患者接受宫腔镜检查获益，3例进行了非侵入性处理。报告了4例轻微不良事件（1例患者发生感染性子宫内膜炎，3例患者发生栓塞后综合征）。
使用明胶海绵条进行子宫动脉近端UAE治疗有症状的高血管化RPOC安全有效。
