title: Novel approach to uterine artery pseudoaneurysm embolization for delayed post-partum hemorrhage.
abstract: Uterine artery pseudoaneurysms (UAP) are a rare cause of post-partum hemorrhage. Conservative management is discouraged due to the risk of spontaneous hemorrhage. Intra-arterial embolization is highly successful (>90%) and offers definitive treatment. We present the case of a 27-year-old woman with significant delayed post-partum hemorrhage after cesarean section who was found to have a UAP on imaging. Her tortuous vascular anatomy and spasmodic aneurysmal neck presented technical challenges to embolization with traditional material, such as gel foam and coils. Intra-arterial thrombin was then employed with good technical and clinical outcome. To our knowledge, this is the first case describing the use of intra-arterial thrombin in the treatment of UAP. Given its success in this case, we argue that intra-arterial thrombin should be considered a viable alternative for embolization of UAP when more traditional techniques fail.
authors.affiliation: Department of Radiology, Madigan Army Medical Center, Tacoma, Washington, USA.
authors.forename: Ross
authors.initials: R
authors.lastname: Parker
authors.affiliation: Department of Radiology, Madigan Army Medical Center, Tacoma, Washington, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Wuerdeman
authors.affiliation: Department of Radiology, Madigan Army Medical Center, Tacoma, Washington, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Grant
authors.affiliation: Department of Radiology, Madigan Army Medical Center, Tacoma, Washington, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Kitley
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D002585:Cesarean Section; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D013917:Thrombin / Q000627:therapeutic use*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D055988:Uterine Artery / Q000601:surgery*; D055357:Uterine Artery Embolization
chemical_list: D006490:Hemostatics; D013917:Thrombin
keywords: Doppler-diagnostic; embolization; post-partum care; post-partum hemorrhage; thrombin; uterine pseudoaneurysm