title: Postpartum hemorrhage from extravasation or pseudoaneurysm: efficacy of transcatheter arterial embolization using N-butyl cyanoacrylate and comparison with gelatin sponge particle.
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) using N-butyl cyanoacrylate (NBCA) for the treatment of active postpartum hemorrhage (PPH) and compare the efficacy of NBCA with gelatin sponge particles.
  
  
  METHODS
  From January 2004 to September 2013, 26 patients with PPH underwent TAE using NBCA as the primary embolic material. All patients were actively bleeding, and 12 (46.2%) had coagulopathy. TAE was performed using 1:2-1:4 mixtures of NBCA and ethiodized oil with or without use of a coil or gelatin sponge. To compare the efficacy of NBCA with conventional embolic material, 50 patients with active bleeding who underwent TAE using gelatin sponge were also analyzed.
  
  
  RESULTS
  Angiograms demonstrated pseudoaneurysm or extravasation or both. The technical and clinical success rates were 100% and 92.3% (24 of 26 patients), respectively, for NBCA and 98% and 86.0% (43 of 50 patients), respectively, for gelatin sponge. In the NBCA group, one patient recovered with conservative management, and the other patient died because of multiorgan dysfunction. There were no major or minor procedure-related complications.
  
  
  CONCLUSIONS
  TAE using NBCA as the primary embolic agent is an effective method for treating PPH with extravasation or pseudoaneurysm; NBCA is comparable to gelatin sponge particles. TAE using NBCA seems to fill pseudoaneurysms and make devascularization more effective than using gelatin sponge.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea.
authors.forename: Kye Jin
authors.initials: KJ
authors.lastname: Park
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea.. Electronic address: jhshin@amc.seoul.kr.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea.
authors.forename: Hyun-Ki
authors.initials: HK
authors.lastname: Yoon
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea.
authors.forename: Dong-Il
authors.initials: DI
authors.lastname: Gwon
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea.
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, 86, Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea.
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D015641:Radiography, Interventional / Q000379:methods; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D004659:Enbucrilate