Management of uterine artery pseudoaneurysm: advanced ultrasonography imaging and laparoscopic surgery as an alternative method to angio-computed tomography and transarterial embolization

Uterine artery pseudoaneurysm is a rare cause of secondary postpartum hemorrhage. Herein, we report a case of uterine artery pseudoaneurysm, with postpartum hemorrhage commencing 22 days after uncomplicated vaginal delivery. Intermittent bleeding occurred during conservative observation. Transvaginal ultrasound color Doppler imaging revealed swollen vascular structures that suggested arteriovenous malformations, and a saccular dilatation of blood vessels. However, it was insufficient to definitively diagnose the condition as pseudoaneurysm. Meanwhile, the three-dimensional computed tomography angiogram was effective in demonstrating a pseudoaneurysm in the uterus, and an absent early venous return sign, leading to the final diagnosis of a pseudoaneurysm. The patient was successfully treated with transarterial embolization using gelatin sponge pledgets. No bleeding or recurrence of the pseudoaneurysm was observed 2 months after embolization.

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Pseudoaneurysm of the uterine artery post loop electrosurgical excision procedure

BMC Women s Health ◽

10.1186/s12905-021-01446-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Judith Ong ◽

Kelvin Lee ◽

Soe-Na Choo ◽

Stanley Loh ◽

Li Min Lim ◽

...

Keyword(s):

Computed Tomography ◽

Vaginal Bleeding ◽

Uterine Artery ◽

Management Options ◽

Artery Pseudoaneurysm ◽

Image Guided ◽

Computed Tomography Angiogram ◽

Uterine Artery Pseudoaneurysm ◽

Loop Electrosurgical Excision ◽

Loop Electrosurgical Excision Procedure

Abstract Background The formation of a uterine artery pseudoaneurysm is rare and isolated cases have been reported in the existing literature following caesarean sections, curettages and cone biopsies. There has been no report of pseudoaneurysm formation following a loop electrosurgical excision procedure. Vaginal bleeding could potentially be life threatening if this diagnosis is not considered following cervical instrumentation or surgery. Management options range from haemostatic sutures, image-guided embolisation to surgical repair. We report the diagnosis and management of a case of uterine artery pseudoaneurysm after a loop electrosurgical excision procedure. Case presentation A 37-year-old woman was diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3) and underwent a therapeutic loop electrosurgical excision procedure. One month after the procedure, the patient presented to the emergency department with repeated episodes of sudden-onset heavy vaginal bleeding associated with hypotension and syncope. A computed tomography angiogram was performed, which demonstrated a pseudoaneurysm of the right uterine artery. Following the diagnosis, image-guided embolisation was performed successfully. Post-embolisation angiograms showed successful embolisation of the pseudoaneurysm and the patient had no further episodes of bleeding. Conclusions Loop electrosurgical excision procedures are generally safe but rarely, can be complicated by the formation of uterine artery pseudoaneurysms. The depth of the loop electrosurgical excision procedure and vascular anatomy should be considered to prevent such complications. A computed tomography angiogram appears to be ideal for diagnosis. Image-guided embolisation is safe and effective as a therapeutic measure, with minimal morbidity.

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A Potentially Useful Addition to Predict Spontaneous Resolution of Uterine Artery Pseudoaneurysm: Absence of Diastolic Flow

Case Reports in Obstetrics and Gynecology ◽

10.1155/2018/2158248 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Yosuke Baba ◽

Hironori Takahashi ◽

Hiroyuki Morisawa ◽

Daisuke Matsubara ◽

Kohei Tamura ◽

...

Keyword(s):

Blood Flow ◽

Uterine Artery ◽

Pulse Wave ◽

Swirling Flow ◽

Transarterial Embolization ◽

Spontaneous Resolution ◽

Artery Pseudoaneurysm ◽

Diastolic Flow ◽

Current Bleeding ◽

Uterine Artery Pseudoaneurysm

Pregnancy-associated uterine artery pseudoaneurysm (UAP) usually requires transarterial embolization (TAE) irrespective of the presence/absence of current bleeding. Some UAP cases spontaneously resolve without TAE; however, such UAP is not well characterized. Here, we suggest that Pulse Wave Doppler may become an addition to predict its spontaneous resolution. A woman underwent 1st-trimester vaginal termination. Vaginal bleeding repeated and, 36 days later, an intrauterine low-echoic mass (24 mm) with swirling blood flow and arterial waveforms (Pulse Wave Doppler) and an enhanced intrauterine sac-like structure without current extravasation were observed, leading to the diagnosis of UAP. Subsequently, the low-echoic mass mostly disappeared but the swirling flow was still observed, with Pulse Wave Doppler revealing arterial flow but the absence of diastolic flow. Finally, the flow disappeared and UAP resolved. This observation reconfirmed spontaneous UAP resolution. The “absent diastolic flow,” possibly indicative of decreased intrasac blood flow, may be a candidate for predicting UAP resolution.

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Ultrasound Imaging of Acquired Myometrial Pseudoaneurysm: The Role of Manipulators as an Unusual Cause during Laparoscopic Surgery

Diagnostics ◽

10.3390/diagnostics12010164 ◽

2022 ◽

Vol 12 (1) ◽

pp. 164

Author(s):

Francesca Buonomo ◽

Clarice de Almeida Fiorillo ◽

Danilo Oliveira de Souza ◽

Fabio Pozzi Mucelli ◽

Stefania Biffi ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Uterine Artery ◽

Secondary Trauma ◽

Color Doppler ◽

Correct Choice ◽

Color Doppler Ultrasound ◽

Artery Pseudoaneurysm ◽

Different Types ◽

Uterine Artery Pseudoaneurysm

An acquired uterine artery myometrial pseudoaneurysm can occur due to inflammation, trauma, or iatrogenic causes, such as surgical procedures, and can lead to profuse bleeding. The efficacy of uterine manipulators in gynecological surgery, particularly as a cause of a pseudoaneurysm, has been poorly discussed in the literature. In this paper, we discuss a case of a 39-year-old woman with profuse uterine bleeding that occurred seven days after operative laparoscopic surgery for endometriosis. The color Doppler ultrasound better evoked the arterial-like turbulent blood flow inside this cavity. These sonographic features were highly suggestive of uterine artery pseudoaneurysm, presumably related to a secondary trauma caused by the manipulator. The diagnosis was subsequently re-confirmed by angiography, and the patient was treated conservatively with uterine artery embolization. Ultrasound has been shown to be a valuable and safe tool for imaging pseudoaneurysm and guiding subsequent interventional procedures. Accordingly, we briefly review the most suitable manipulators used in benign gynecological surgeries to verify if the different types in use can guide the surgeon towards the correct choice according to surgical needs and thus prevent potentially dangerous trauma.

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Postpartum hemorrhage caused by uterine artery pseudoaneurysm: A case report

Case Reports in Women s Health ◽

10.1016/j.crwh.2021.e00286 ◽

2021 ◽

Vol 29 ◽

pp. e00286

Author(s):

Danielle Glassman ◽

Ruchi Karsalia ◽

Issam Moubarak ◽

Mark V. Sauer ◽

Ashima Singla

Keyword(s):

Case Report ◽

Postpartum Hemorrhage ◽

Uterine Artery ◽

Artery Pseudoaneurysm ◽

Uterine Artery Pseudoaneurysm

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Overview of Neo-Vascular Lesions after Delivery or Miscarriage

Journal of Clinical Medicine ◽

10.3390/jcm10051084 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1084

Author(s):

Yuji Shiina

Keyword(s):

Arteriovenous Malformations ◽

Uterine Artery ◽

Spontaneous Regression ◽

Vascular Diseases ◽

Vascular Lesions ◽

Artery Pseudoaneurysm ◽

Retained Products Of Conception ◽

Products Of Conception ◽

Uterine Artery Pseudoaneurysm ◽

Retained Products

The concept of intrauterine neo-vascular lesions after pregnancy, initially called placental polyps, has changed gradually. Now, based on diagnostic imaging, such lesions are defined as retained products of conception (RPOC) with vascularization. The lesions appear after delivery or miscarriage, and they are accompanied by frequent abundant vascularization in the myometrium attached to the remnant. Many of these vascular lesions have been reported to resolve spontaneously within a few months. Acquired arteriovenous malformations (AVMs) must be considered in the differential diagnosis of RPOC with vascularization. AVMs are errors of morphogenesis. The lesions start to be constructed at the time of placenta formation. These lesions do not show spontaneous regression. Although these two lesions are recognized as neo-vascular lesions, neo-vascular lesions on imaging may represent conditions other than these two lesions (e.g., peritrophoblastic flow, uterine artery pseudoaneurysm, and villous-derived malignancies). Detecting vasculature at the placenta–myometrium interface and classifying vascular diseases according to hemodynamics in the remnant would facilitate the development of specific treatments.

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