Management of arterial and venous hemorrhage during sacrospinous ligament fixation: cases and review of the literature.
OBJECTIVE
Sacrospinous ligament fixation (SSLF) for pelvic organ prolapse repair can incur significant intraoperative hemorrhage. Management of vascular injury is challenging because of limited visualization of the surrounding pararectal space and is not well described in the literature.


METHODS
We evaluate cases of intraoperative venous and arterial hemorrhage during SSLF. Based on a review of the literature, we present a systematic approach to the treatment of venous and arterial hemorrhage associated with SSLF.


RESULTS
Vascular injury to the hypogastric and pudendal venous plexi may be controlled using directed compression and topical hemostatic agents. Vascular injury to the inferior gluteal artery, its coccygeal branch, or other arteries, may require embolization.


CONCLUSIONS
Life-threatening bleeding is a rare complication of transvaginal SSLF. Knowledge of surrounding pelvic vascular anatomy, treatment options, and communication with ancillary staff is essential for the treatment of sacrospinous ligament hemorrhage.
Urogynecology, University of Pennsylvania, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA, 19104, USA. avita.pahwa@uphs.upenn.edu.
Avita K
AK
Pahwa
Urogynecology, University of Pennsylvania, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Lily A
LA
Arya
Urogynecology, University of Pennsylvania, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Uduak U
UU
Andy
D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D056887:Pelvic Organ Prolapse / Q000601:surgery*
Bleeding; Hemorrhage; Pelvic embolization; Pelvic hematoma; Sacrospinous ligament fixation