2025/10/14 by Kupfer, Sivert, Haslinger, Christian, Pfammatter, Thomas
Medicine · #610 Medicine & #Gynecological conditions and treatments #Maternal and fetal healthcare #Postpartal uterine hemorrhage #Uterine Myomas and Treatments #Uterine arteriovenous anomaly #Uterine arteriovenous malformation #Uterine artery embolization #health
paper · doi:10.5167/uzh-280661
openalex publication_date 2025/10/14 · openalex created_date 2025/12/11 · openalex updated_date 2026/07/28
Objectives: To evaluate clinical presentation, imaging features, embolization techniques and their outcome for acquired uterine vascular anomalies (UVA) related to obstetric events. Materials and methods: Thirteen women (mean age = 34; range = 20-40 years) who had undergone interventional radiological treatment of UVAs between 2013 and 2024 were retrospectively analyzed. All patients had a history of an obstetric event. They presented with ongoing postpartal vaginal blood losses (n = 11) or were asymptomatic (n = 2). Fertilization had been performed by intracytoplasmic sperm injection (ICSI) in 3/13 women. 7/13 women had delivered healthy babies. 6 women had surgical, drug-induced or missed abortions. Postpartum dilatation and curettage had been performed in 4 women. The delay between the obstetric/gynecological event and the radiological intervention ranged from 19 to 193 days (median = 49 days). Long-term follow-up was available in 12/13 patients (median FU = 2.4 years). Unilateral selective transcatheter embolization was performed in 7/12 patients (n-Butyl-Cyanoacrylate-Lipiodol mixture [BCAL], n = 5; trisacryl gelatine particles, n = 2); Bilateral uterine artery embolization was performed in 5/12 women (unilateral BCAL combined with contralateral particles in 3/12, or bilateral gelatine sponge slurry in 2/12). In one patient percutaneous direct injection of BCAL into a uterine artery branch pseudoaneurysm was performed. Results: Primary clinical success without complications was achieved in 10/13 interventions. Re-embolization was successful in the 3 patients with ongoing bleeding despite uterine artery embolization. Follow-up information was available in 12/13 patients (median FU = 2.4 yrs). The pregnancy rate after embolization was 8/12women with a birth rate of 6/8 pregnancies. Conclusion: Embolization of acquired UVAs is an effective and safe treatment. Preservation of uterine function for future pregnancy after uterine transarterial embolization seems warranted.