title: Vascular complication after sacrospinous ligament fixation with uterine preservation.
abstract: OBJECTIVE
  Sacrospinous ligament fixation (SSLF) is a minimally invasive transvaginal procedure for correcting apical prolapse. Amongst perioperative complications, life-threatening hemorrhage has a reported occurrence rate ranging from 0.2 % to 2 %. We present a case of arterial hemorrhage following SSLF and a multispecialty approach to its successful management.
  
  
  METHODS
  The video demonstrates the development of an unexpected progressive postoperative hematoma following left-side sacrospinous hysterocolpopexy via the anterior approach, despite minimal intraoperative bleeding. The mechanism of formation of the hematoma could have been laceration of an aberrant vaginal branch of the inferior vesical artery secondary to pulling the anchor which is tied off at the cervix after closure. To treat these patients effectively, it is essential for the surgeon to make a timely diagnosis, and in our patient, embolization of the inferior vesical artery provided a safe and effective treatment for the pelvic hemorrhage that eliminated the need for an invasive surgical intervention.
  
  
  CONCLUSIONS
  Life-threatening bleeding is a rare complication of transvaginal SSLF. Pelvic vessel embolization can provide an effective, minimally invasive alternative to surgical re-exploration.
authors.affiliation: Medanta Institute of Kidney & Urology, Medanta - The Medicity Hospital, Sector 38, Gurgaon, 122001, Haryana, India. amitaurogynae@gmail.com.
authors.forename: Amita
authors.identifier: http://orcid.org/0000-0002-5109-8912
authors.initials: A
authors.lastname: Jain
authors.affiliation: Division of Peripheral Vascular & Endovascular sciences, Medanta - The Medicity Hospital, Gurgaon, Haryana, India.
authors.forename: Virender Singh
authors.initials: VS
authors.lastname: Sheorain
authors.affiliation: Division of Radiology & Nuclear Medicine, Medanta - The Medicity Hospital, Gurgaon, Haryana, India.
authors.forename: Kulbeer
authors.initials: K
authors.lastname: Ahlawat
authors.affiliation: Division of Urology & Renal Transplant, Fortis Escorts Kidney & Urology Institute, Fortis Escorts Hospital, New Delhi, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Ahlawat
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000628:therapy*; D008022:Ligaments / Q000601:surgery*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: Hemorrhage; Pelvic embolization; Pelvic hematoma; Sacrospinous hysterocolpopexy; Sacrospinous ligament fixation