Transcatheter arterial embolization for primary postpartum hemorrhage: predictive factors for embolic material conversion of gelatin sponge particles to N-Butyl cyanoacrylate

Background Identification of the source of postpartum hemorrhage (PPH) is important for embolization because PPH frequently originates from non-uterine arteries. Purpose To evaluate the clinical importance of identifying the non-uterine arteries causing the PPH and the results of their selective embolization. Material and Methods This retrospective study enrolled 59 patients who underwent embolization for PPH from June 2009 to July 2016. Angiographic findings and medical records were reviewed to determine whether non-uterine arteries contributed to PPH. Arteries showing extravasation or hypertrophy accompanying uterine hypervascular staining were regarded as sources of the PPH. The results of their embolization were analyzed. Results Of 59 patients, 19 (32.2%) underwent embolization of non-uterine arteries. These arteries were ovarian (n = 7), vaginal (n = 5), round ligament (n = 5), inferior epigastric (n = 3), cervical (n = 2), internal pudendal (n = 2), vesical (n = 1), and rectal (n = 1) arteries. The embolic materials used included n-butyl cyanoacrylate (n = 9), gelatin sponge particles (n = 8), gelatin sponge particles with microcoils (n = 1), and polyvinyl alcohol particles (n = 1). In 13 patients, bilateral uterine arterial embolization was performed. Re-embolization was performed in two patients with persistent bleeding. Hemostasis was achieved in 17 (89.5%) patients. Two patients underwent immediate hysterectomy due to persistent bleeding. One patient experienced a major complication due to pelvic organ ischemia. One patient underwent delayed hysterectomy for uterine infarction four months later. Conclusion Non-uterine arteries are major sources of PPH. Detection and selective embolization are important for successful hemostasis.

Download Full-text

The Analysis of Risk Factors Associated with Transcatheter Arterial Embolization for Percutaneous Nephrolithotomy

10.21203/rs.2.12932/v1 ◽

2019 ◽

Author(s):

Hongfei Miao ◽

Yong Chen ◽

Peng Ye ◽

Qingle Zeng ◽

Huajin Pang

Keyword(s):

Risk Factors ◽

Percutaneous Nephrolithotomy ◽

Transcatheter Arterial Embolization ◽

Clinical Success ◽

Univariate Analysis ◽

Postoperative Bleeding ◽

Arterial Embolization ◽

Gelatin Sponge ◽

Bleeding Control ◽

Embolic Material

Abstract Abstract Background: This study aimed to evaluate the risk factors of transcatheter arterial embolization (TAE) in managing haemorrhage associated with percutaneous nephrolithotomy (PCNL) to improve the surgical effect. Methods: From May 2007 to June 2018, 112 patients (31–60 years) who underwent TAE treatment for haemorrhage after PCNL were retrospectively analyzed. All patient data and embolization details were retrieved from medical records. Univariate analysis was used to identify the risk factors related to clinical outcomes. Results: Technical and clinical success rates were 100% and 93%, respectively. On angiography, we observed injury to the main artery in 1 patient, to secondary branch in 22, to tertiary branch in 58, and to both secondary and tertiary branches in 31. Embolic agents were coils (n =31), gelatin sponge (n=15), and gelatin sponge with coils/microcoils (n =66). Bleeding control failed in 8 patients. Eight patients opted for a second operation, 6 by repeat TAE and 2 by surgery. Bleeding was eventually controlled in all patients. Univariate analysis indicated that extent of transfusion, embolic material used, and injured branches were significantly associated with clinical failure. Conclusions: TAE is effective and safe in treating postoperative bleeding after PCNL. Massive transfusion, embolic material used, and injured branches were related to failure of bleeding control.

Download Full-text