Predictors of radiation dose for uterine artery embolisation are angiography system-dependent

This study sought to achieve radiation dose reductions for patients receiving uterine artery embolisation (UAE) by evaluating radiation dose measurements for the preceding generation (Allura) and upgraded (Azurion) angiography system. Previous UAE regression models in the literature could not be applied to this centre’s practice due to being based on different angiography systems and radiation dose predictor variables. The aims of this study were to establish whether radiation dose is reduced with the upgraded angiography system and to develop a regression model to determine predictors of radiation dose specific to the upgraded angiography system. A comparison between Group I (Allura, n = 95) and Group II (Azurion, n = 95) demonstrated a significant reduction in KAP (kerma-area product) and Ka, r (reference air kerma) by 63% (143.2 Gy·cm2 vs 52.9 Gy·cm2; P < 0.001, d = 0.8) and 67% (0.6 Gy vs 0.2 Gy; P < 0.001, d = 0.8), respectively. The multivariable linear regression (MLR) model identified the UAE radiation dose predictors for KAP on the upgraded angiography system as total fluoroscopy dose, Ka, r, and total uterus volume. The predictive accuracy of the MLR model was assessed using a Bland-Altman plot. The mean difference was 0.39 Gy·cm2 and the limits of agreement (LoA) were +28.49 and -27.71 Gy·cm2, and thus illustrated no proportional bias. Our findings validated the upgraded angiography system and its advance capabilities to significantly reduce radiation dose for our patients. Interventional radiologist and interventional radiographer familiarisation of the system’s features and the implementation of the newly established MLR model would further facilitate dose optimisation for all centres performing UAE procedures using the upgraded angiography system.

Imaging spectrum of acquired uterine vascular abnormalities with angiographic correlates, a pictorial review

Background Acquired uterine arterial anomalies, including uterine artery pseudoaneurysms (UAP), arteriovenous malformations (AVMs) and arteriovenous fistulae (AFVs), are rare presenting causes of abnormal uterine bleeding. Timely diagnosis is essential for safe and effective treatment, avoiding life-threatening haemorrhage resulting from erroneous uterine curettage due to misdiagnosing these as other more common differentials. Main text This pictorial review discusses the ultrasound (USG), CT and MRI features of various acquired uterine vascular abnormalities with angiographic correlates. Conclusion Acquired uterine arteriovenous injuries are a fundamental cause of dysfunctional intractable bleeding recalcitrant to traditional conservative management. Endovascular transcatheter uterine artery embolisation is an increasingly popular and safe mode of treatment, especially in young patients desiring to have the option of future pregnancies, with lesser morbidity and in-hospital stay duration.

Uterin artery embolisation: a rescuer in cervical ectopic pregnancy

Cervical ectopic pregnancy is an extremely rare form of ectopic pregnancy with potential risk of massive bleeding and associated morbidity. Managing this condition is challenging for clinicians due to the serious risk to patient and dilemma faced in deciding the appropriate management plan. This case report describes the role of uterine artery embolisation in managing a case of cervical ectopic pregnancy with heavy bleeding per vaginum post methotrexate treatment with falling beta human chorionic gonadotropin (HCG) levels. It highlights the unpredictable nature of this condition and need for prompt intervention in an emergency situation.

Successful management of secondary postpartum haemorrhage due to post caesarean wound dehiscence with uterine artery embolisation

Caesarean scar dehiscence usually presents as secondary postpartum haemorrhage (PPH) with persistent spotting, fever or abdominal distension. The known management are either with laparotomy followed by resuturing of the scar or hysterectomy. However, most of the patient ultimately undergo hysterectomy due to the persistence of vaginal bleeding. We presented a case of PPH secondary due to scar dehiscence post lower segment caesarean section (LSCS), which was successfully managed with bilateral uterine artery embolization without hysterectomy. Our patient presented with vaginal bleeding on 16th post LSCS day and USG showed presence of a hyperechoic area measuring 5×6 cm more towards the right angle suggestive of the scar dehiscence with hematoma. She underwent bilateral uterine artery embolization and had decreased in the vaginal bleeding with gradual regression in the size of the hematoma over a period of time. Radiological intervention with bilateral uterine artery embolization (UAE) can be used as one of the modalities of management for the hemodynamically stable patient.

The Effect of Prophylactic Uterine Artery Embolisation On Reproductive Outcomes In Caesarean Scar Pregnancy Patients: A Propensity Score-Matched Study

Purpose: This study aimed to investigate the effect of prophylactic uterine artery embolisation (UAE) on reproductive outcomes in caesarean scar pregnancy (CSP) patients.Methods: Clinical data of CSP patients diagnosed at Shengjing Hospital of China Medical University from January 2014 to December 2019 were collected. According to inclusion and exclusion criteria, 181 patients with reproductive needs were selected and divided into UAE group (n = 51) and non-UAE group (n = 130) according to whether the patient received preventive UAE before their hysteroscopic or laparoscopic operation. The basic characteristics and pregnancy outcomes of individuals of the groups were compared, and propensity score matched (PSM) analysis was used to produce 37 matched pairs.Results: Before PSM, the UAE group had a thinner muscle layer, larger mass size, and higher serum human chorionic gonadotropin level than the non-UAE group. The pregnancy rate and live birth rate of the UAE group were 54.9% and 61.9%, respectively, which were lower than those of the non-UAE group (61.5% and 66.7%), but no statistical differences were observed. Post-PSM, no significant differences between basic characteristics of the groups were observed. The pregnancy rate of the UAE group was 51.4%, lower than that of the non-UAE group (73.0%). The live birth rate of the UAE group was 64.3%, also lower than that of the non-UAE group (72.7%); however, the difference was not statistically significant.Conclusion: Prophylactic UAE is a safe and effective adjuvant treatment for CSP, and has no significant effect on subsequent pregnancy and live birth rates.