title: Uterine Artery Embolization for Retained Products of Conception with Marked Vascularity: A Safe and Efficient First-Line Treatment.
abstract: OBJECTIVE
  To report our clinical practice regarding a case series of retained products of conception (RPOC) with marked vascularity (MV) managed with selective uterine artery embolization (UAE) as first-line treatment.
  
  
  METHODS
  This was a monocentric, retrospective study of 31 consecutive cases of RPOC with MV diagnosed by Doppler ultrasound in the context of postpartum/postabortal bleeding. The primary outcome was the absence of rebleeding following embolization.
  
  
  RESULTS
  RPOC with MV occurred after abortion in 27 out of 31 patients (87%). The time elapsed between delivery/abortion and UAE ranged from 1 to 210 days (mean 55.7 ± 45 days). Primary clinical success was achieved in 23 women (74.2%) following a single embolization. In total, 27 out of 31 women (87%) had been exclusively managed by UAE with conservative success. Although procedural success was achieved in this number, six women had a further procedure to evacuate RPOC despite procedural success. Large uterine arteriovenous (AV) shunts associated with RPOC were observed in five cases (16.1%), among which two were successfully treated after a single UAE and one after two UAEs, while hysterectomy was performed in the last two cases despite two and three UAE procedures respectively. RPOC was histologically proven in ten cases (32.2%) including four out of five cases of uterine AV shunt.
  
  
  CONCLUSIONS
  RPOC with MV can present with large uterine AV shunt, particularly in case of late management. Uterine artery embolization is an effective and safe first-line treatment, and should be evaluated for this indication in larger prospective trials.
authors.affiliation: Département d'Imagerie Diagnostique et interventionnelle, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100, Angers, France. paul.bazeries@chu-angers.fr.
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0002-5883-6180
authors.initials: P
authors.lastname: Bazeries
authors.affiliation: Département d'Imagerie Diagnostique et interventionnelle, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100, Angers, France.
authors.forename: Francine
authors.initials: F
authors.lastname: Paisant-Thouveny
authors.affiliation: Département d'Imagerie Diagnostique et interventionnelle, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100, Angers, France.
authors.forename: Sultan
authors.initials: S
authors.lastname: Yahya
authors.affiliation: Département d'Imagerie Diagnostique et interventionnelle, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100, Angers, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Bouvier
authors.affiliation: Département d'Imagerie Diagnostique et interventionnelle, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100, Angers, France.
authors.forename: Cosmina
authors.initials: C
authors.lastname: Nedelcu
authors.affiliation: Département de Gynécologie et Obstétrique, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100, Angers, France.
authors.forename: Francoise
authors.initials: F
authors.lastname: Boussion
authors.affiliation: Département de Gynécologie et Obstétrique, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100, Angers, France.
authors.forename: Loic
authors.initials: L
authors.lastname: Sentilhes
authors.affiliation: Département d'Imagerie Diagnostique et interventionnelle, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100, Angers, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Willoteaux
authors.affiliation: Département d'Imagerie Diagnostique et interventionnelle, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100, Angers, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Aubé
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D000792:Angiography; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D055988:Uterine Artery / Q000000981:diagnostic imaging; D055357:Uterine Artery Embolization / Q000379:methods*; D014599:Uterus / Q000098:blood supply*; D055815:Young Adult
keywords: Postpartum hemorrhage; Retained products of conception; Uterine arterial embolization; Uterine arteriovenous malformation