Post-operative hemorrhage after myomectomy: safety and efficacy of transcatheter uterine artery embolization.
OBJECTIVE
To evaluate the safety and clinical efficacy of transcatheter uterine artery embolization (UAE) for post-myomectomy hemorrhage.


METHODS
We identified eight female patients (age ranged from 29 to 51 years and with a median age of 37) in two regional hospitals who suffered from post-myomectomy hemorrhage requiring UAE during the time period from 2004 to 2012. A retrospective review of the patients' clinical data, uterine artery angiographic findings, embolization details, and clinical outcomes was conducted.


RESULTS
The pelvic angiography findings were as follows: hypervascular staining without bleeding focus (n = 5); active contrast extravasation from the uterine artery (n = 2); and pseudoaneurysm in the uterus (n = 1). Gelatin sponge particle was used in bilateral uterine arteries of all eight patients, acting as an empirical or therapeutic embolization agent for the various angiographic findings. N-butyl-2-cyanoacrylate was administered to the target bleeding uterine arteries in the two patients with active contrast extravasation. Technical and clinical success were achieved in all patients (100%) with bleeding cessation and no further related surgical intervention or embolization procedure was required for hemorrhage control. Uterine artery dissection occurred in one patient as a minor complication. Normal menstrual cycles were restored in all patients.


CONCLUSIONS
Uterine artery embolization is a safe, minimally invasive, and effective management option for controlling post-myomectomy hemorrhage without the need for hysterectomy.
Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
Alvin Yu-Hon
AY
Wan
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
Ji Hoon
JH
Shin
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
Hyun-Ki
HK
Yoon
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
Gi-Young
GY
Ko
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
Sangik
S
Park
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, Korea.
Nak-Jong
NJ
Seong
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, Korea.
Chang-Jin
CJ
Yoon
D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000098:blood supply / Q000601:surgery*; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000009:adverse effects / Q000379:methods*; D014594:Uterine Neoplasms / Q000098:blood supply / Q000601:surgery*; D014599:Uterus / Q000098:blood supply / Q000601:surgery
Digital subtraction angiography; Uterine artery embolization; Uterine myoma; Uterine myomectomy